Volunteer Info

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?

Availability

Rows	MON	TUE	WED	THUR	FRI	SAT	SUN
Morning
Afternoon
Evening

How often do you plan on volunteering?

Opportunities (This list is not all inclusive)

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"

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.

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

Beechwood Home Volunteer Applicant Information Sheet