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 about Faith in Action? *

Why are you interested in volunteering with Faith in Action? *

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

Employment/Experience (describe):

Do you wish to be paired with: *

Male

Female

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

Check areas you are willing to work in: *

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

Yes

No

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

A background check is required. Do you agree to have a background check? *

Yes

No

Any information shared is strictly confidential. It is because we work with a vulnerable population, that a background check is required. You will be asked to provide your social security number, which will not be kept on file.

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, whether by either the agency or the care receivers, will be kept confidential.

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