VOLUNTEER APPLICATION
Name
*
Dr.
Mr.
Mrs.
Ms.
Prefix
First Name
Last Name
Date of Birth
-
Month
-
Day
Year
Date
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
Please enter a valid phone number.
Type of phone
*
Please Select
Cell
Home
Work
Email
example@example.com
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Education (indicate highest completed)
*
Minor (under 18 in school)
High School/ GED
Associates
Bachelors
Masters
Doctorate
We welcome volunteers of all ages. We require volunteers under the age of 18 to provide a completed Parental/ Guardian Consent Form from the Volunteer Handbook. This must be received before or on your first day of volunteer service.
Are you currently a student?
Yes
No
Where?
Are you currently employed?
Yes
No
Where?
Job title
Volunteer area of interest (check all that apply)
*
Clerical
Landscape
Event planning
Event set up
Fundraising
Community outreach
Spiritual care
Other
Days & times available (check all that apply)
*
Any
Sun AM
Sun PM
Mon AM
Mon PM
Tues AM
Tues PM
Wed AM
Wed PM
Thur AM
Thur PM
Fri AM
Fri PM
Sat AM
Sat PM
Can you commit to volunteering for at least 3 months?
Yes
No
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Please indicate interest/ skills you would be willing to use as a volunteer (check all that apply):
Public speaking
Grant writing
Sign language
Foreign language
Fundraising
Volunteer recruiting
Public relations
MS Office suite
Google Drive
Adobe Creative Cloud
Jotform
Canva
Other
Which foreign language can you translate?
Are you fulfilling any type of required community service hours?
*
Yes
No
Please explain.
Do you have any limitations related to health?
*
Yes
No
Please explain.
Have you ever been convicted of a felony or crime?
*
Yes
No
Please explain.
Did a former/ current staff member or volunteer refer you to Healing Hands?
Yes
No
Who?
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Emergency contact
*
First Name
Last Name
Relationship
Please Select
Significant other
Parent
Adult child
Sibling
Friend
Phone Number of Emergency Contact
*
Please enter a valid phone number.
I certify the statements I have made here are true and accurate. By signing this application, I agree that I render these health care services voluntarily and without compensation or the expectation of compensation. This acknowledgement and agreement has been made before rendering my services. I have been advised to review the Healing Hands Health Volunteer Handbook. I agree to report to the appropriate persons any incidents or injuries in which I am involved with during my volunteer service. I understand my service as a volunteer is covered up to the limits specified by the center's insurance program and I hereby waive any claim against Healing Hands Health except as specified therein.
*
We welcome volunteers of all ages. We require volunteers under the age of 18 to provide a completed Parental Consent Form from the Volunteer Handbook. This must be received before or on your first day of volunteer service.
Submit
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