APPLY TO VOLUNTEER (must be 18 years of age or over) Click here for a printable pdf version NAME       Last First Middle Initial ADDRESS         Street City State Zip PHONE (HOME)     (WORK)   (CELL) EMAIL ADDRESS   BIRTHDAY EMPLOYER   POSITION STUDENT? YES NO IF SO, WHERE? CHURCH AFFILIATION  ARE YOU BEING REQUIRED TO COMPLETE VOLUNTEER HOURS FOR ANY REASON (SCHOOL, ORGANIZATION, COURT ORDER, HABITAT FOR HUMANITY, SHARE PROGRAM, ETC.?) NO YES, I MUST COMPLETE  HOURS FOR (REASON) CHOOSE WHICH AREA YOU WOULD LIKE TO VOLUNTEER FOR: Childcare - Childcare is needed at various times throughout the day and evening Monday through Friday so parents can Receiving Center - Available Monday through Friday 8:00 to 5:00 p.m. and Saturdays, 9:00-4:00 p.m. April through August or b Sorting Center (Basement) - Available Monday through Friday from 9:00 to 3:00 p.m. during summer months, April through August. Food Services - Lunch Shift - Lunch shift from 11:45 a.m. until 1:00 p.m. Lunch on Sunday’s starts at 1:00 p.m Food Services - Dinner Shift - Dinner shift from 4:45 p.m. until 6:00 p.m. Dinner on Sunday’s starts at 6:00 p.m. Other - please specify SKILLS AND INTERESTS EDUCATION/BACKGROUND  HOBBIES/SKILLS/INTERESTS  PREVIOUS VOLUNTEER EXPERIENCE HOW DID YOU HEAR ABOUT VOLUNTEER OPPORTUNITIES AT HOME SWEET HOME MINISTRIES? Friend Advertisement Church Agency Client Staff Member Volunteer Center/School Radio/Television Newspaper/Brochure Other PLEASE LIST TWO REFERENCES     Name Telephone Relationship Name Telephone Relationship CONTACT IN CASE OF EMERGENCY     Name Telephone AFFIDAVIT OF CONFIDENTIALITY Home Sweet Home Ministries adheres to the principle of maximum confidentiality and follows the mandates of the Illinois statutes and regulations as from time to time provided, and as currently specified in the Mental Health Confidentiality Act. Accordingly all board members, staff, volunteers, and others associated with the operation of this establishment shall keep all information regarding clients or agency business in general in strictest confidence. I understand the requirements for confidentiality and agree to abide thereby. I further understand that a violation of confidentiality requirements could result in immediate termination of my involvement with Home Sweet Home Ministries, Inc. Date // (mm/dd/yyyy)