Name *

First

Last *

Last

DOB

Address *

Address

City

State/Province

Zip/Postal

Home Phone *

Cell Phone

Work Phone

Can we call your work? *

Yes

No

Email *

How did you learn of this program? *

Why are you interested in working with this program? *

Do you have experience working with interfaith groups? (Please explain): *

Do you wish to be paired with: *

Female

Male

Either

Do you wish to provide services to: *

Frail Elderly

Terminally Ill

Disabled

Any

Have you worked with either of these populations before? (Please explain) *

Can you volunteer: *

Please indicate the services you would like to provide: *

Do you drive? *

Yes

No

Own a car? *

Yes

No

If needed, will you consider a case outside of your immediate area? *

Yes

No

Check areas you are willing to work in: *

If needed: May we match you with a smoker? *

Yes

No

Volunteers who smoke are asked to refrain from smoking, even if matched with a smoker.

May we match you with a pet owner? *

Yes

No

Do you have pet allergies? *

Yes

No

Do you speak any other language? *

Yes

No

Languages spoken: *

Do you know American Sign Language? *

Yes

No

Can you be called upon to translate? *

Yes

No

Have you ever been convicted of a crime? *

Yes

No

Having a conviction does not necessarily preclude you from volunteering. Any information shared is strictly confidential. Because we work with a vulnerable population, a background check may be required.

If yes, please explain *

Please list FIVE personal references who are not members of your family or household:

Name *

First

Last *

Last

City/State *

Phone Number *

Add Remove

In case of Emergency please notify:

Name *

First

Last *

Last

Relationship

Address

City

State/Province

Zip/Postal

Home Phone

Cell Phone

Work Phone

All of the above information is true and correct to the best of my knowledge. I understand that should I be selected as a volunteer, that I will provide services to Faith in Action’s target population to the best of my abilities. All information shared with me, by either the agency or the care receivers will be kept confidential. I also understand that Faith in Action is an interfaith organization, which provides services to enrolled care recipients regardless of denomination, faith community, or religious belief. I further understand that the philosophy of Faith in Action respects all forms of religious belief and spirituality, as defined by the person requesting or providing services; as a result, I agree to not engage in any proselytizing (converting) activities.

Confirm *

I Confirm

Comments:

Online Volunteer Application

Please list FIVE personal references who are not members of your family or household:

In case of Emergency please notify:

Funding & Support