VOLUNTEER APPLICATION
Instilling hope • Empowering lives
Thank you for your interest in serving families at Community Rescue Mission.
APPLICANT INFORMATION
Full name
First Name
Last Name
Preferred name
First Name
Last Name
Street address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone
Format: (000) 000-0000.
Email
example@example.com
Date of birth
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Is this for Court or Community Service?
No
Yes
If yes how many hours do you need?
Are you under age 18?
No
Yes
— if yes, a parent/guardian signature is required.
EMERGENCY CONTACT
Contact name
First Name
Last Name
Relationship
Phone
Format: (000) 000-0000.
Alternate phone
Format: (000) 000-0000.
VOLUNTEER INTERESTS Check all that interest you
Volunteer Interests
Prepare or serve meals
Organize the donation room
Administrative or office support
Cleaning, painting or maintenance
Children's activities or tutoring
Life-skills classes or mentoring
Special events and fundraising
Donation drives and wish-list projects
Yard work or seasonal projects
Professional or skilled services
Faith-based activities
Other
SKILLS & EXPERIENCE
Please describe relevant experience, training, certifications, languages or special skills:
Why would you like to volunteer with Community Rescue Mission?
Community Rescue Mission • P.O. Box 607, Fort Smith, AR 72904 • info@fscrm.org • www.fscrm.org
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AVAILABILITY
Monday
Times available
Tuesday
Times available
Wednesday
Times available
Thursday
Times available
Friday
Times available
Flexible / as needed
Preferred start date
Preferred frequency
Volunteer hours needed?
VOLUNTEER SERVICE DETAILS
Are you volunteering through a school, employer, church, civic group, court or other organization?
No
Yes
Organization / program
Coordinator name
Coordinator phone / email
Required hours / deadline
REFERENCES
Reference 1
Phone / email
Reference 2
Phone / email
SCREENING & SAFETY
Community Rescue Mission serves families and children. Depending on the assignment, volunteers may be asked to complete an interview, orientation, reference check, background check or additional screening before placement.
Have you ever been convicted of, pleaded guilty or no contest to, or received deferred adjudication for an offense other than a minor traffic violation?
No
Yes
A "yes" response does not automatically disqualify an applicant. If yes, please explain below. Do not include Social Security numbers or other highly sensitive identifiers on this form.
Click or tap to enter an explanation, if applicable
VOLUNTEER AGREEMENT
I certify that the information in this application is accurate to the best of my knowledge.
I agree to follow Community Rescue Mission policies, maintain resident confidentiality, respect appropriate boundaries and complete required training.
I understand that submitting this application does not guarantee placement and that volunteer assignments may be changed or ended at any time.
I authorize Community Rescue Mission to contact the references and organizations listed on this application for volunteer-screening purposes.
Applicant signature
Date
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Parent / guardian signature
Date
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
FOR OFFICE USE ONLY
Orientation / screening
Assignment / start date
Preview PDF
Submit
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