Contact Information
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First Name:*
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Last Name:*
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Address:*
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City:*
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State:*
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Zip Code:*
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Phone:*
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Email Address:*
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Birthday:*
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Would you like to be added to our e-newsletter list?
YesNo |
Optional Information
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This section is optional. You do not have to fill it out...
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| Gender: MaleFemale
Education Completed:
Some High SchoolHigh SchoolSome CollegeCollegeVocational/Technical |
Race:
African-AmericanAsianCaucasianNative AmericanOther |
Skill Area
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| 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.
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Experience
Please list any previous volunteer experience beginning with the most recent. Include organization name, position, dates (from/to), supervisor name, supervisor phone number.
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| Have you voluteered with or been employed by Welcome House before?
YesNo
If so, when?
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Are you currently employed?
YesNo
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Full time/Part time?
Full timePart time
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Occupation:
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Name of Employer:
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Work Phone:
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Email Address:
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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.
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In case of emergency please contact
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Name:
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Relationship:
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Phone Number:
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How did you hear about Welcome House?
Word of mouthInternetSchoolPlace of employmentNewspaperTV/radioChurchBrochureOther
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| 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.
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Signature:
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Date of Application:
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