JW House Volunteer Application

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. With a small staff, House operations are primarily run by weekly volunteers - from greeting guests, giving tours, setting up for meals, light food preparation when necessary, and light cleaning. It is a truly rewarding experience to be able to support adults and children who are going through a difficult time, and provide them with the comforts of home.
Please fill out the application below if you are interesting in becoming a House Volunteer. Weekly volunteers are scheduled for one 3-4 hour shift (of the same time) each week and must be able to commit to at least six months of service.

On-call shifts are also available if you cannot make a regular weekly commitment.
Personal Information
First Name: *
Last Name: *
City: *
State: *
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: *
What volunteer opportunities are you interested in? *
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 (9:30am-12:30pm)
Afternoon (12:30pm-4:00pm)
Evening (4:00pm-7:15pm)

Language Proficiencies

Enter any languages you read, write, or speak (other than English).
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.
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 *

Month Day Year
Date
Should be Empty:

Weekly House Volunteer Application

Personal Information

Background

Volunteer Experience

Availability

Language Proficiencies

References

Criminal Background Information

Agreement