Volunteer Info

Beechwood Home Volunteer Applicant Information Sheet
Full Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
E-mail*
Phone:

Area CodePhone Number
Cell Phone:

Area CodePhone Number
Birth Date*

MonthDayYear
What is the best way to contact you?*

EmailPhone

Availability

	MON	TUE	WED	THUR	FRI	SAT	SUN
Morning
Afternoon
Evening

How often do you plan on volunteering?

WeeklyMonthlyEvery other monthQuarterlyYearlyAs Needed
Opportunities (This list is not all inclusive)

AdministrationArts & CraftsBible StudyBingo on WeekendsBoard Games/Card GamesBook ClubDecoratingGardeningLead DiscussionsMen's GroupMusicPersonal VisitsPet Care/VisitsReadingSupport GroupTransportWrite Letters for ResidentsSpecial Events & PartiesOther
Please list specific skills, hobbies,qualifications and/or abilities that you have acquired from employment, previous volunteer work or through other activities:
How did you hear about The Beechwood Home
Please summarize any previous volunteer experience:
Have you volunteered for Beechwood in the past"

YesNo
When and what department?
Criminal Background Have you ever been convicted of a felony or misdeameanor? No Yes You may exclude: a. Traffic violations for which the fine imposed was $300 or less; b. Any conviction that has been sealed, expunged or legally eradicated; c. Any offense which as finally settled in juvenile court or referred to the youth authority; d. Any misdemeanor conviction for which probation has been successfully completed or otherwise discharged AND the case has been judicially dismissed.*

YesNo
Please explain:
*** All volunteers will have a background check run via electronic fingerprinting performed on-site at The Beechwood Home.***
Agreement: By submitting this application, I affirm that the facts set forth in it are true and complete. I authorize BWH to verify any information relevant to my suitability as a volunteer. I understand that if I am accepted as a volunteer, any false statements, omissions or other misrepresentations made by me on this application may result in my immediate dismissal from any volunteer assignment. If I am under the age of 18, this agreement represents parental consent*

I Agree
Should be Empty:

Beechwood Home Volunteer Applicant Information Sheet