Volunteer Application – United Crescent Hill Ministries

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: *

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 *