APPLY TO VOLUNTEER
(must be 18 years of age or over)
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NAME
Last
First
Middle Initial
ADDRESS
Street
City
State
Zip
PHONE PH
BUSINESS PH
CELL PH
EMAIL ADDRESS
BIRTHDAY
EMPLOYER
POSITION
ARE YOU VOLUNTEERING WITH A GROUP?
YES
NO GROUP NAME?
ARE YOU A STUDENT?
YES
NO 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)
EDUCATION/BACKGROUND
PREVIOUS VOLUNTEER EXPERIENCE
DESIRED FREQUENCY TO VOLUNTEER AT HSHM
YEARLY
MONTHLY
WEEKLY
DAILY
OTHER
Please indicate which area you would like to volunteer in:
Children´s Programming
Special Events
Adopt-A-Meal/Supper Club
Adult Programming
Warehouse/Rcvng-Sorting Donations
Food Preparation
Clerical-Office Help
Maintenance
Meal Server
Drives (Food, clothing, etc.)
Errand Driver
Holiday Meals
Other
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
CONTACT IN CASE OF EMERGENCY:
Name
Relationship
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)
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