Weekly House Volunteer Application
JW House keeps families together by offering a welcoming home close to Silicon Valley hospitals, with a caring and compassionate environment that inspires hope. Every volunteer makes a difference in the lives of our guests. Please fill out our volunteer application if you'd like to become a Weekly House Volunteer.
Personal Information
Today's Date:
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Month
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Day
Year
First Name:
Last Name:
Street Address:
City:
State:
Zip Code:
Phone Number:
Email:
example@example.com
How did you hear about JW House?
Background
Education Completed:
High School or Equivalent
College Graduate
Some College or Technical School
Other
Are you currently employed?
Yes, full-time
Yes, part-time
No
Retired
Current or Previous Employer:
Occupation:
Volunteer Experience
Organization:
Role:
Is this a current role?
Yes
No
Date: from
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Month
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Day
Year
Date: to
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Month
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Day
Year
Organization:
Role:
Is this a current role?
Yes
No
Date: from
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Month
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Day
Year
Date: to
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Month
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Day
Year
Community Affiliations:
Skills, Interests, and Hobbies:
Availability
Please indicate your general availabilities for volunteering on a weekly basis - check as many blocks as your schedule permits. A specific day and time for your chosen assignment will be discussed during your interview.
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
Morning (9:00am-12:30pm)
Afternoon (12:30pm-4:00pm)
Evening (4:00pm-7:30pm)
Language Proficiencies
Enter any languages you read, write, or speak (other than English).
Language:
Fluency:
Read
Write
Speak
Language:
Fluency:
Read
Write
Speak
References
List two individuals not related to you and that you have known at least one year.
Name:
Relationship:
Email
example@example.com
Phone Number:
Name:
Relationship:
Email
example@example.com
Phone Number:
Criminal Background Information
In answering the following questions, do not disclose misdemeanor marijuana-related convictions that are more than two years old; convictions that have been expunged, sealed, or statutorily eradicated; misdemeanor convictions for which probation has been successfully completed or discharged and the case has been judicially dismissed; or any referrals to a pre-trial or post-trial diversion program.
Full Legal Name:
Have you ever been convicted of or pled guilty to a felony?
Yes
No
Have you ever been convicted of or pled guilty to a misdemeanor that might be related in some way to the position for which you are applying (including convictions such as those relating to honesty, integrity, or illegal use of drugs)?
Yes
No
If you answered “Yes” to either of these two questions regarding convictions, please describe the convictions(s) in detail, including dates:
Agreement
The statements I have made on this form are true and correct to the best of my knowledge. I understand any omission of facts by me is cause for immediate dismissal.
I understand that I am volunteering my services without contemplation of compensation or employment and given with humanitarian, religious or charitable reasons.
I release JW House and its operating divisions and agents from any and all claims, causes of action, and liabilities arising out of any and all investigation, background checks, and verification of the information I have provided and its determination of any qualifications and abilities.
I understand that, if accepted as a volunteer, I will be required to abide by all of the policies, rules, and regulations of the JW House.
Digital Signature
Clear
Date
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Month
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Day
Year
Date
Submit Application
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