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:

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