| * Required Fields |
|
| > Today's Date: |
(MM/DD/YYYY) |
|
| |
* |
| > First Name:* |
|
|
| > Last Name:* |
|
|
| > Date of Birth:* |
(MM/DD/YYYY) |
|
| > Address:* |
|
| |
|
|
| > City:* |
|
|
| > State:* |
|
|
| > ZIP:* |
|
|
| > Email:* |
|
|
| > Home Phone:* |
|
|
| > Work Phone: |
|
|
| > Cell Phone: |
|
|
| > Call Preference:* |
|
|
| > Best Time to Reach: |
(00:00pm or 00:00am) |
|
| > What is your cultural identification?: |
|
|
| > Current Employment Status:* |
|
|
> If employed,
Employer Name: |
|
|
| > Occupation: |
|
|
| > Employer offers a time-off program for volunteers?:* |
|
|
| > Employer offers a donation-matching program?:* |
|
|
| If you are a student, please tell us: |
| > Does your school require that you complete community service hours?:* |
|
|
| > Name of your School: |
|
|
| > Field of Study/Major: |
|
|
| In case of emergency, who can we notify: |
| > Name:* |
|
|
| > Relationship to you:* |
|
|
| > Phone:* |
|
|
Do you speak any language, other than English?
If so, please indicate: |
| > Language 1: |
|
| > Language 1 conversational fluency: |
|
|
| > Language 2: |
|
| > Language 2 conversational fluency: |
|
|
| > How did you hear about volunteer opportunities at George Mark Children's House?: |
|
|
| > Have you experienced a personal loss through a death? If so, what was the relationship and how recently was the death?: |
|
|
| > After reviewing the Volunteer Opportunities at GMCH, please check the boxes that most interest you: |
|
|
| > Do you have special skills?: |
|
| > Other: |
|
|
| > Why are you interested in volunteering in GMCH?: |
|
|
| We need TWO references. Please no relatives; preferably a supervisor/former supervisor/teacher if available. |
|
| REFERENCE 1 |
| > Name:* |
|
| > Telephone:* |
|
| > Relationship to you:* |
|
| > Street Address:* |
|
| > City:* |
|
| > State:* |
|
| > ZIP:* |
|
| > Email:* |
|
| > Phone - Home:* |
|
|
| REFERENCE 2 |
| > Name:* |
|
| > Telephone:* |
|
| > Relationship to you:* |
|
| > Street Address:* |
|
| > City:* |
|
| > State:* |
|
| > ZIP:* |
|
| > Email:* |
|
| > Phone - Home:* |
|
|
| > Have you ever been terminated from employment, penalized or suspended from employment for inappropriate action with children, or have you ever been accused of inappropriate action with children in your personal life? * |
|
* |
If yes, please describe in detail:
*
|
|
| Thank you for considering George Mark Children's House as an opportunity for volunteering and service. We appreciate the time and thought involved in completing this application. |
|
| |
|
