First Name *

Last Name *

DOB *

Address *

Address

City

State/Province

Zip/Postal

Home Phone *

Cell Phone

Work Phone

May we call you at work? *

Yes

No

E-mail Address *

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) *

Availability: *

Please indicate the services you would like to provide: *

Do you drive? *

Yes

No

Own your own car? *

Yes

No

Driver's License number *

Dropdown

Expiration Date: *

Auto Insurance Carrier *

Policy # *

Insurance Coverage Limits *

** A copy of your proof-of-insurance is required

Expiration Date *

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 criminal history 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 THREE personal references who are not members of your family or household:

Name *

First

Last *

Last

City/State *

Phone Number *

Add Remove

Name *

First

Last *

Last

City/State *

Phone Number *

Add Remove

Name *

First

Last *

Last

City/State *

Phone Number *

Add Remove

In case of Emergency please notify:

First Name *

Last Name *

Relationship

Address *

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, 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

Signature

Clear

Online Volunteer Application

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

In case of Emergency please notify:

Funding & Support