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
/
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(mm/dd/yyyy)