Page 1 of 5 Volunteer Application Contact Information (all information is required) Full Date Home / Cell Date of Birth Social Security Number E-Mail Address (Note: All volunteers must have a valid driver s license and their own means of transportation.) Person to Notify in Case of Emergency (s) E-Mail Address
Page 2 of 5 Have you ever been convicted of criminal charge? Circle Yes or No Have you ever been charged with a felony? Circle Yes or No Have you ever been accused of abuse or neglect of a child or an adult? Circle Yes or No Have you ever been involved with child protective services or juvenile court that resulted in the removal of a child? Circle Yes or No If you answered yes to any of the above, please explain in the space provided. How You Can Help The Charlotte HT Roundtable can get you plugged in with the following ministries: Lily Pad Haven, Inc. Justice Ministries On Eagles Wings Ministries Present Age Minstries Vigilante Truth www.lilypadhaven.org www.justiceministries.org www.oewhope.org www.presentageministries.org www.vigilantetruth.com
Page 3 of 5 Please check all areas you are interested in volunteering Administrative/Office assistance (mailings) Marketing Outreach (Web, Social Media, Email, etc.) Meal Coordination Donor Retention Volunteer Appreciation Education Job Training Assist with retail connections and shipment of product Fundraising activities Grant Writing & Research Mentoring Men s Outreach Organization and Donation Management Securing and/or delivering item donations Research Speakers Bureau (churches, civic organizations, home groups, workplace, etc.) Transportation to Appointments Yard Work & Light Maintenance Prevention programs Other: Special Skills: Please summarize special skills and qualifications you have acquired from employment, previous volunteer work, or through other activities, including hobbies or sports. Previous Volunteer Experience: Please summarize any previous volunteer experience.
Page 4 of 5 Availability: Please tell us when you are available to volunteer Weekday mornings Weekday afternoons Weekday evenings Weekend mornings Weekend afternoons Weekend evenings I can commit for: (please circle one) 3 months 6 months 9 months 12 months Should your availability change please contact Mike at 803-448-9177 or MikeSextonNC@gmail.com Agreement and Signature By submitting this application, I affirm that the facts set forth in it are true and complete. I understand that if I am accepted as a volunteer, any false statements, omissions, or other misrepresentations made by me on this application may result in my immediate dismissal. NOTE: To participate in any local programs activities you may be asked to complete a full background check which you will be charged any applicable fees associated with the background check. (printed): Signature: Date:
Page 5 of 5 References References 1 Pastor/church leader Home / Cell Reference 2 Home / Cell Reference 3 Home / Cell Please note: All of your references will be contacted.