Volunteer Application

Volunteer Application

Local - Roseville CA
Thank you for your interest. Please read before you begin the Application process.
1. It is not recommended to complete this Application on a mobile device.
2. Please allow yourself at least 30 minutes to complete the application, consisting of multiple pages of essay questions.
3. If you cannot finish the Application in one sitting, you can "Save" and continue later. However, to do so, you must create a Login and Password with Jotform, which hosts our online forms.
4. Please fill out the Application entirely. Please write "does not apply" or N/A if a question does not apply.
5. If selected for an interview, you may be asked to submit your pastor's recommendation letter. If you prefer, you may upload your letter of recommendation during this Application process, if prompted.
6. Turning in an Application does not guarantee you an interview. If you are selected for an interview, you will be contacted directly. Being offered an interview does not guarantee you a volunteer position.
7. If you are offered a Volunteer position, there is a required $25-95 Training Fee, depending on the position.
8. Please note all volunteer positions require a one-year commitment.
Sierra Pregnancy + Health (SPH) is a not-for-profit medical clinic. We believe all life is sacred. We provide reproductive healthcare services, practical assistance, education, and resources to meet the needs of women facing unplanned pregnancies in the community.

All volunteers are expected to annually review and affirm their agreement with our Statements and Agreements, as stated below in our Application, as a condition of affiliation with the clinic regarding doctrinal belief and practical application.
Agreements
You MUST agree with our Volunteer Agreement, Statement of Faith & Code of Christian Conduct, and Confidentiality Agreement to be considered for a volunteer position.

Do you fully agree with the...*

	Yes	No	Unsure
Volunteer Agreement
Statement of Faith & Code of Christian Conduct
Confidentiality Agreement

Signature

By submitting this application, I confirm that the facts set forth in it are true and complete. I understand that if I am accepted as a volunteer, any false statements, omissions, or other misrepresentations made by me on this application will result in my immediate dismissal.
Signature

Your Information
Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email*
example@example.com
Phone Number*
Please enter a valid phone number.
Date of Birth*

MonthDayYear
Date
Drivers License #*
Spouse's Name
Children's Names and Ages

Volunteer Medical Staff Applicants
Are you applying for a volunteer medical staff position?

YesNo
Have you ever referred for, promoted, performed, witnessed, or participated in an abortion procedure (both surgical and medication abortion)? If yes, please explain.
What is your position on abortion as a medical provider (not including ectopic pregnancy)?
What type of nursing do you do, or have you done in your career? (Examples, Cardiac, Oncology, OB, E.R., etc.)?
Are you an RN, LVN, CNA, or MD?
How long have you been licensed to practice Nursing or as a Medical Doctor?
Is your medical license valid and up to date in the State of California as of the date you are filling out this application? If not, please explain.
Are you currently working in a paid position as a Nurse or Doctor? If so, where and what is your schedule?
Are your currently volunteering as a Nurse or Doctor?
Are you certified in Sonography? If so, have you provided ultrasounds for first and second trimester pregnancies?

Employment
Are you currently employed?*

YesNoSeeking
Where do you work?
What is your job title?
How long have you worked there?
How many hours do you work in a week?
What is your position there?
Volunteer Work
Are you currently volunteering at an organization, school, church, company, etc?*

YesNo
How many hours do you volunteer in a week?
Tell me about your current volunteer comittments:

Your Christian Faith
Do you consider yourself a Christian?*

YesNoUnsure
Describe Christianity according to your understanding: *
Are you an active church member?*

YesNoSearching
Name/City of Church: *
Describe your Church participation such as positions held and services you perform in the Church: *
Describe your walk with Christ: *

Interest
Please state in detail why are you are interested in volunteering at Sierra Pregnancy + Health. *
Skills, Talents, Degrees, Certifications
What special skills, talents, gifts or personality traits would you bring to SPH? *
What degree, licensing, or training do you hold that would be a benefit to SPH? *
What is your comfort level using computers, passwords and software?

1

2

3

4

5

1 is Avoid, 5 is Confident
Most of our volunteer positions require computer usage. Please explain your experience and ability to use a computer and electronic record keeping.

Emergency Contact
Emergency Contact Name*
Your Relationship*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Primary Phone*
Please enter a valid phone number.
Secondary Phone
Please enter a valid phone number.
Email*
example@example.com
References

(3 PEOPLE NOT RELATED TO YOU, AND THOSE WHO KNOW YOU WELL)
Reference #1 Name *
Reference #1 Relationship*
Reference #1 Email*
example@example.com
Reference #1 Phone Number*
Reference #2 Name*
Reference #2 Relationship*
Reference #2 Email*
example@example.com
Reference #2 Phone Number*
Reference #3 Name*
Reference #3 Relationship*
Reference #3 Email*
example@example.com
Reference #3 Phone Number*
We may require a recommendation letter from your Pastor if you are selected for an interview. If you already have a letter, please upload it here.

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