Volunteer Application

Do you have any previous work experience with persons who are mentally or physically disabled? Explain:

Do you have any previous volunteer experience in other areas? Explain:

Are you related to or acquainted with any client of New Hope Village? Name & Relationship:

Do you have any friends or relatives working at New Hope Village? Name & Relationship:

Do you have any medical problems or physical restrictions that we should be aware of?

Do you take any medication that we should be aware of?

Do you have any hobbies, skills, talents, or interests that may be useful or of interest to New Hope Village?

Educational background or certifications that will be useful in your service to New Hope Village:

If you are a student, please list your school and current grade level:

Emergency Contact Information: (This person can be contacted in the event of an emergency.)

Emergency Contact Name:

Relationship to you:

Phone during your work shift:

Alt. Phone:

Personal Reference

OTHER THAN RELATIVES, list one personal reference. (Use employer, former employer, school, church, civic group, New Hope employee, etc.)

Name:

Relationship to you:

Address:

City:

State:

Zip Code:

Phone:

Alt. Phone:

Volunteer’s Background/Security Check

Please answer the following questions

Do you use illegal drugs?

Yes No

Have you ever been convicted of a criminal offense?

Yes No

Have you ever been charged with neglect, abuse or assault?

Yes No

Has your driver’s license ever been suspended or revoked?

Yes No

If you answered yes to any of the questions in this section, please explain:

Agreement

I certify that the information provided on my application is true and complete to the best of my knowledge. I have not withheld any information that could affect my application unfavorable, if included. I understand that New Hope Village may refuse to allow me to volunteer if I provided any incorrect information or omission. I understand that my volunteer service can be modified or terminated without notice or cause, at any time.

I HAVE READ AND UNDERSTAND THIS DISCLOSURE AND AUTHORIZATION TO OBTAIN INFORMATION.

Signature

Date

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Volunteer Application

Personal Information

Emergency Contact Information: (This person can be contacted in the event of an emergency.)

Personal Reference

OTHER THAN RELATIVES, list one personal reference. (Use employer, former employer, school, church, civic group, New Hope employee, etc.)

Volunteer’s Background/Security Check

Please answer the following questions

Agreement

Careers

ClientServices

BusinessServices

GetInvolved