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Volunteer Application
P.O. Box 932 Nicholasville, KY 40340
Name: ______Address: ______
City:______State:______Zip:______
Date of Birth ______Phone/Day:______Evening:______
Email:______
Current Employer ______May We Call You at Work? ______
Spouse’s Name ______Spouse’s Employer ______
Church affiliation, membership, or attendance______
Have you ever been charged with a misdemeanor or criminal offense? ______
If yes, please attach an explanation.
Have you ever been convicted with a misdemeanor or criminal offense? ______
If yes, please attach an explanation.
(Note: a conviction does not necessarily eliminate potential volunteers in the application process. The nature of the offense and the amount of time since the offense will be considered in the approval process. Give all facts so an appropriate decision can be made).
Personal References:
Provide three personal references (excluding relatives) whom you have known for at least one year and can attest to your character, skills and dependability.
Name______Relationship ______
City ______Day Time Phone ______Email Address ______
Name______Relationship ______
City ______Day Time Phone ______Email Address ______
Name______Relationship ______
City ______Day Time Phone ______Email Address ______
Previous Volunteer Experience / Skills/ Comments
Please summarize any previous volunteer experience and agencies served. Special skills and qualifications you may have acquired through work, volunteering, hobbies or sports.
______
Special Skills or QualificationsArea of Interest
___Arts & Crafts___Childcare Assistant
___Board Games / Puzzles___Hospital Companion
___Computer Skills___Craft Time
___Construction___Meal Preparation
___Drawing___Donation Organizer
___Fundraising___Administrative Assistant
___Gardening / Landscaping___Special Events
___Grant writing___Grounds work
___Hair Stylist___Painting
___Holidays (decorating, gift wrapping, etc)
___Jewelry Making
___Make-up / Hair, etc.
___Music
___Photography
___Physical Fitness
___Scrap booking
___Sewing
___Sports
___Tutoring
Emergency Contact Information
Person to contact:______Relationship: ______
Phone:Day:______Evening: ______
Pledge of Confidentiality and Agreement / Signature
I hereby pledge that I shall safeguard and treat as CONFIDENTIALall information (whether acquired through verbal communication, written record, or observation) pertaining to any resident, relative or friend of any resident, staff member or volunteer of All God’s Children, which I may through my affiliation with AGC so acquire.
By submitting this application, I also agree that the information provided is complete and true. 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.
Signature:______Date: ______
Please Print Name:______
All God’s Children Policy
It is the policy of this organization to provide equal opportunities without regard to race, color, religion, national origin, gender, sexual preference, age, or disability.
Thank you for completing this application and for your interest in volunteering with us!