Volunteer Application

Name *

First

Last

Date of Birth *

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Phone *

Email *

Date Available to Begin *

Occupation

Days/Times Available to Volunteer *

Emergency Contact *

Emergency Contact Phone *

Please list any previous volunteer experience. *

What interests you in volunteering with UCHM? *

Have you ever been convicted or plead guilty to a crime? (Background check required) *

Yes
No

If you answered yes to the previous question, please explain:

Personal Reference #1 *

First

Last

Phone

Email *

Personal Reference #2 *

First

Last

Phone

Email *

Personal Reference #3 *

First

Last

Phone

Email *

I am interested in volunteering in the following areas: *

Would you like to sign up for our newsletter to stay up to date on new volunteer opportunities?

Applicant Statement

The information contained in this application is correct to the best of my knowledge. I authorize any references listed on this application to release any information that they may have regarding my characterand fitness to work in a volunteer capacity. I release any individual, group, or agency, both individually and collectively, from any liablity because of compliance or attempts to comply with this authorization. Should I be accepted, I agree to be bound by the bylaws and policies of United Crescent Hill Ministries and its programs. I further state that I have carefully read and understand the foregoing release and I sign this release of my own free act.

Name *

First

Last

Date / Time *