Volunteer Application

Age Group *

Gender *

Female

Male

Name *

Name

First Name

Last Name

Address *

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Driver's License #

California Driver's License Number

Phone *

Phone

(###)

###

####

Alternate Phone

(###)

###

####

Email *

Do you have a car? *

Yes

Car Insurance & Registration? *

Yes

Are you able to transport residents to appointments or the store? *

Yes

Occupation

Are you looking for a Practicum or Intern Position? *

Yes

Prior Volunteer Experience

Please list the names and phone numbers of two (2) prior volunteer references:

What do you consider your skills/expertise and talents to be?

Do you have any training or desire to be a birth coach?

Yes

What do you consider as your areas of weakness?

Days that you are available *

Check all that apply

Monday

Tuesday

Wednesday

Thursday

Friday

Saturday

Sunday

Hours of availability

What is your preferred area of work at Elizabeth House? *

Office, Childcare, Transportation, etc.

Please list any major medical problems that you have

Diabetes, High Blood Pressure, etc.

Do you have any physical limitations?

Unable to lift heavy items or sit/stand for long periods of time, etc.

Have you had a TB test in the past 12 months? *

Yes

If yes, please indicate date and result:

If no, are you willing to have a TB test?

Yes

Please answer the following questions:

In volunteering at Elizabeth House, you may work directly or indirectly with the children who live here. For that reason, we would like your cooperation in answering the following questions.

Have you ever been convicted of a crime (not including a minor traffic offense)? *

Yes

If yes, please indicate offense(s) and date(s):

Are you currently using illegal drugs? *

Yes

Have you ever been arrested or convicted of a drug or alcohol-related crime? *

Yes

If yes, please indicate offense(s) and date(s):

Have you ever been arrested for or convicted of a charge of child abuse, of actual or attempted sexual molestation of a minor, or of an offense involving violent behavior? *

Yes

If yes, please indicate offense(s) and date(s)

Are you currently involved in a local church?

Yes

Name of Church

Please explain how you are involved

Please give a brief description of your spiritual journey

Please tell us why you are interested in volunteering at Elizabeth House

Terms & Conditions *

I confirm that all of the above information is correct. I authorize Elizabeth House to investigate all statements contained in this application for the purpose of considering me for a volunteer opportunity. I am offering my services on a volunteer basis and I understand that Elizabeth House can terminate the volunteer relationship at any time. I give Elizabeth House permission to conduct a background check including check of my criminal record and my motor vehicle report (driving record).

I agree

If you are interested in volunteering your time at Elizabeth House, please fill out the volunteer application. Once we have received your application electronically, our volunteer coordinator will contact you about volunteer opportunities that match your skills and interests.