Name  Email
Address 
City      State:    CA   Zip 
Home Phone Work Phone Emergency Contact  Phone Referral Source

What motivated your desire to become involved with this ministry?
 

Please state the days and times you would be available to volunteer:
 

What length of service are you interested in? long term short term

Please check all areas of interest below:

Office & clerical Phones & reception Admin. work Crafts/Hobbies

Job Readiness Sorting & organizing Haircut Children's Ministry

Maintenance Clothing room Transportation

 Teaching Computer skills Teaching classes (what type of classes)

^{Other (Please Describe)}  

List any education or training that would assist you in volunteering:

Are you employed: Yes  No             Full-time     Part-time

What skills do you use at work?

Where are you employed? (optional)

Are you a student? Yes   No  

If yes, are you doing this for credit? Yes  No

(If yes, please provide us with the necessary information including your Measurable Learning Objectives form, hours needed, and instructors name and number).

List any previous or current volunteer experience or relevant work related activities you are currently doing or have done:

Current church involvement:

Where?   How long?

Pastors name:    Phone #

References

Friend   Phone #

Friend   Phone #

Other    Phone #

Due to the confidentiality we provide our residents, it is very important that you also adhere to this principal:  Whom you see here stays here.  (See 42 U.S.C.)

Volunteers must be at least 18 years of age unless accompanied by an adult.