JW House Volunteer Application

VOLUNTEER APPLICATION
Personal Information
Today's Date:

Month 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

Month Day Year
Date: to

Month Day Year
Organization:
Role:
Is this a current role?

Yes No
Date: from

Month Day Year
Date: to

Month Day Year
Community Affiliations:
Skills, Interests, and Hobbies:
Availability
Please indicate your general availabilities for volunteering - 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

Morning (8:30am-12:30pm)

Afternoon (12:30pm-4:30pm)

Evening (4:30pm-8:30pm)

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:
Driving Record
Do you have a current driver's license?

No Yes
Yes - Driver's License Number:
State Issued:
Are there any current restrictions of your driver's license?

No Yes:
Yes - Restrictions:
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

Month Day Year
Date
Should be Empty:

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VOLUNTEER APPLICATION

Personal Information

Background

Volunteer Experience

Availability

Language Proficiencies

References

Criminal Background Information

Driving Record

Agreement