VOLUNTEER APPLICATION

GRACE Volunteer Application
Today's Date

MonthDayYear
Date
Name

First NameMiddle NameLast Name
Physical Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email
example@example.com
Primary Phone Number
Please enter a valid phone number.
Phone Type

CellHomeWork
Secondary Phone Number
Please enter a valid phone number.
Phone Type

CellHomeWork
Preferred Contact Method

PhoneEmailText
Race
Gender

MaleFemale
Date of Birth
Employment Experience:
Previous Volunteer Experience:
List any Health Restrictions:
Emergency Contact:

First NameLast Name
Emergency Contact's Phone Number:
Please enter a valid phone number.
Doctor's Name:

First NameLast Name
Doctor's Phone Number:
Please enter a valid phone number.
Have you ever been convicted of a felony?

YesNo
Have you ever been convicted of any criminal offense?

YesNo
If yes, please explain:
If you are offering to help delivery/pick up furniture or transport adults:
Do you drive your own car/truck?

YesNo
Have you had any traffic violations in the last 5 years?

YesNo
If yes, please explain:
My automobile insurance company is:
The date my driver's license expires is:

Please provide the following information for two persons who know you well:

	Full Name	Address	Phone	Relationship
Reference 1
Reference 2

Times available to volunteer; check all that apply:

MorningAfternoonEvening
Days available to volunteer; check all that apply:

MondayTuesdayWednesdayThursdayFridaySaturdaySunday
I AM INTERESTED IN VOLUNTEERING IN THE FOLLOWING AREAS:
ANOTHER TIME AROUND THRIFT SHOP

Help price donations at the storeWork a shift up to 4 hours on set schedule when store is open (Store Hours: Wed. thru Sat. 10am to 4pm)Work a shift up to 4 hours as cashier when store is open
BOARD & COMMITTEE OPPORTUNITIES

Serving as Corporate Officer (Chair, Vice-Chair, Secretary, Treasurer) on our BoardServing on our Governing BoardHelping with brochures, newsletters, website, Community Connections, etc.Helping with organizing, planning, and executing fundraiser effortsHelping with insurance, budgets, accounting software, annual audit, etc.Help with writing grantsHelping with current programs - Christmas Gift, School Supply, Thanksgiving, Household Items
GRACE PROGRAMS

Household Item ClosetSchool Supply DriveThanksgiving Box ProgramChristmas Gift Program
FAMILY SERVICES

Being a Budget Mentor and helping families develop good spending habitsBuilding a ramp or other construction projectCutting/delivering wood to a family for heatingMowing grass, cleaning gutters, or other yard work for an elderly or disabled personHousecleaning for a familyOffering professional services such as plumbing, heating, electrical, automotive repairsProviding transportation to GED classes, doctor's appointments, etc.Pick up and deliver furniture
GRACE OFFICE

Computer input into our database, spreadsheets, etc.Cleaning the office periodicallyBecoming a case worker, working closely with the families who are seeking helpBecoming a receptionist or helping with clerical duties
TECHNICAL SUPPORT

Work to develop, make changes, maintain our databaseWork to develop, make changes, maintain our websiteProvide training on databaseBe on call for emergency computer needsAdvise, shop, purchase, install needed technical items for GRACE office
OTHER
Please describe other interests or talents you wish to share with others.
Thank you for your interest. We recognize that GRACE will only be as strong as its members.

VOLUNTEER AGREEMENT

I am interested in offering my volunteer services to GRACE and agree to become familiar with and adhere to GRACE's policies and procedures. By my signature below, I hereby agree to the following:

CRIMINAL RECORD STATEMENT

I am aware that my volunteer assignment through GRACE may bring me in contact with vulnerable populations (school-aged, pre-school children, elderly and/or disabled individuals). If my volunteering puts me in direct unsupervised contact with clients, I hereby give permission to GRACE to submit my name for a criminal check. I hereby affirm that the information provided in my application with respect to my criminal record is true and correct.

VOLUNTEER CONFIDENTIALITY AGREEMENT

I agree not to disclose of a personal and confidential nature except to those individuals who need to know. I also understand that similar information learned about other GRACE volunteers and/or staff is also to be treated as confidential. I agree not to use the GRACE database to research clients that are not part of my job responsibilities. I agree to talk to an appropriate staff member in any situation in which I have questions about confidentiality and/or my possible violation of such confidentiality.

CONSENT TO EXCHANGE INFORMATION

I give permission for GRACE to use my photograph for promotional purposes.

LIABILITY RELEASE

I understand that the nature of the volunteer activities may involve physical activity, contact with unidentified and unfamiliar persons, travel to and from various unspecified locations and other potential risks of injury. Knowing this, I still wish to volunteer and hereby assume these risks with respect to any liability for any accident or injury to persons or property which I may sustain in connection with my volunteer activity. In addition, I hereby release and discharge GRACE and any of its management staff, program managers, volunteer leaders (Executive Board and Board of Directors), volunteer station supervisors, employees, affiliates, and their successors from any and all liability or responsibility for any such accident or injury.

If I use my personal automobile to transport a client, I will arrange to keep in effect my automobile liability insurance equal to (at least the minimum) the requirement of the State of Virginia.
I have read and agree to these conditions.

Clear
Should be Empty:

GRACE Volunteer Application

If you are offering to help delivery/pick up furniture or transport adults:

I AM INTERESTED IN VOLUNTEERING IN THE FOLLOWING AREAS: