Volunteer Application - Hope House of McAlester

Name*

First Last

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Email*

Home Phone*

Work Phone

Date of Birth*

Emergency Contact Name*

Emergency Contact Phone*

Race

(for reporting purposes only)

Due to the confidential and sensitive nature of our work, all volunteers must complete a background check. Your driver's license number and/or Social Security number is required for this check.

DL# and State*

SSN*

What areas are you interested in? (Please check each area in which you would be willing to volunteer)

Administrative Offices

Office Work
Special Projects
Fund raising

Training Program

(Training in technical assistance, newsletter)

Office Work
Special Mailings
Special Events

Prevention Programs

(Presentations in schools)

Kindergarten and First Grades
Third and Fifth Grades
Seventh Grade
Office Work

Which days of the week would you be available for the programs?

Monday
Tuesday
Wednesday
Thursday
Friday
Weekends

When would you prefer to volunteer?

Mornings
Afternoons
Evenings

How often would you like to be scheduled?

Once a week
Once every two weeks
Once a month
When needed

Education*

Work Experience*

Volunteer Experience*

Why would you like to volunteer with Hope House of McAlester?*

Have you ever (a) experienced any abuse or (b) had child abuse confirmed against you?

If yes to either, please explain.

Have you ever been convicted of any charges other than minor traffic violations?

If yes, please explain.

Please list three references with telephone numbers.*

Please check to agree below.*

I agree that any information I gain as a result of participating in a Hope House of McAlester program or activity will be held in strict confidence.

Please check to agree below.*

In connection with my volunteer application, I hereby authorize release to Hope House any and all information concerning my criminal history, personal background and any other information which may be beneficial in determining my qualifications and fitness for the volunteer position(s) for which I am applying.