Contact Information

1. Your Name(required)
2. Street Address(required)
3. City(required)
4. State(required)
5. Zip Code(required)
6. CDL#
7. Phone [h]
8. Phone [w]
9. Phone [c]
10. Email(valid email required)

Experience

1. Do you have a car?
2. yes no
3. Do you have car insurance?
4. yes no
5. Occupation
6. Prior Volunteer Experience
7. What do you consider your skills/expertise and talents to be?
8. Do you have any training or desire to be a birth coach?
9. What do you consider as your area(s) of weakness?
10. What is your preferred area of volunteer work at Elizabeth House?
11. Computer Skills Office assistance Answering phones Teaching Mentor Transportation Babysitting House Manager relief Sort Donations Fundraising or Special Events House Maintenance Other
12. If you chose 'Other' please list here

Availability

1. Days that you are available [ check all days that apply ]
2. Monday Tuesday Wednesday Thursday Friday Saturday Sunday
3. Hours of availability
4. Do you have any physical limitations? (Unable to lift heavy items or stand/sit for long periods of time etc. )
5. Have you had a TB test in the last 12 months?
6. Yes No
7. If yes, please indicate:
8. Date:
9. Result:
10. If no, are you willing to have TB test?
11. Yes No

Criminal Record

1. Have you ever been convicted of a crime (not including a minor traffic offense)?
2. Yes No
3. If yes, please indicate offense(s) and date(s):
4. Are you currently using illegal drugs?
5. Yes No
6. Have you ever been arrested or convicted of a drug or alcohol-related crime?
7. Yes No
8. If yes, please indicate offense(s) and date(s):
9. 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?
10. Yes No
11. If yes, please indicate offense(s) and date(s):

Church Involvement

1. Are you currently involved in a local church?
2. Yes No
3. Name of Church
4. Please explain your involvement
5. Please give a briefly describe your spiritual journey:
6. Please write one or two paragraphs about why you are interested in volunteering at Elizabeth House

References

1. Please list the names and phone numbers of two (2) references who know you well (example, pastor, friend, co-worker)
2. Reference #1 Name
3. Reference #1 Phone (h)
4. Reference #1 Phone (w)
5. Reference #2 Name
6. Reference #2 Phone (h)
7. Reference #2 Phone (w)

 

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