Volunteer Application Form

    Contact Information

    First Name:*
    Last Name:*
    Address:*
    City:*
    State:*
    Zip Code:*
    Phone:*
    Email Address:*
    Birthday:*
    Would you like to be added to our e-newsletter list?
    YesNo

    Optional Information

    This section is optional. You do not have to fill it out...
    Gender: MaleFemale

    Education Completed:
    Some High SchoolHigh SchoolSome CollegeCollegeVocational/Technical

    Race:
    African-AmericanAsianCaucasianNative AmericanOther

    Skill Area

    Areas you are experienced/trained in:

    Arts & CraftsChildcareComputers/TechnologyCookingEvent Planning/FundraisingHealth/Human ServicesInterviewing SkillsOffice SkillsOrganizingTeaching/TutoringOther
    If Other:

    Areas you are interested in:

    Arts & CraftsChildcareComputers/TechnologyCookingEvent Planning/FundraisingHealth/Human ServicesInterviewing SkillsOffice SkillsOrganizingTeaching/TutoringOther
    If Other:

    Are you interested in a specific position?

    YesNo If so, what?

    Direct Service Opportunities?

    YesNo

    In-Direct Service Opportunities?

    YesNo

    Availability

    Please list times and number of hours per week you are interested in volunteering.

    Experience

    Please list any previous volunteer experience beginning with the most recent. Include organization name, position, dates (from/to), supervisor name, supervisor phone number.

    Have you voluteered with or been employed by Welcome House before?

    YesNo
    If so, when?

    Are you currently employed?
    YesNo
    Full time/Part time?
    Full timePart time
    Occupation:
    Name of Employer:
    Work Phone:
    Email Address:

    Convictions

    Please complete this section if you have ever been convicted of a crime including but not limited to: a misdemeanor and/or felony conviction. (A criminal conviction does not automatically mean that you cannot volunteer at Welcome House).

    Have you ever been convicted of a crime?
    YesNo

    List all misdemeanor and felony convictions with dates. You may include any mitigating factors that you feel should be considered.

    In case of emergency please contact

    Name:
    Relationship:
    Phone Number:

    How did you hear about Welcome House?

    Word of mouthInternetSchoolPlace of employmentNewspaperTV/radioChurchBrochureOther
    If Other:

    I certify that the information I have written is true to the best of my knowledge and that Welcome House of Northern KY has my permission to contact the above references.

    I understand that the staff at Welcome House will make final determination regarding the use of my volunteer services in keeping with the best interests of the organization and it's programs.

    Signature:
    Date of Application:

    Enter the letters and numbers below into the box:
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