Pettengill House Volunteer Application

Pettengill House Volunteer Application
Thank you for your interest in joining our team of highly valued volunteers at The Pettengill House, Inc. Please note that our volunteer positions sometimes require physical stamina, walking stairs, and lifting. Due to safety and confidentiality, volunteer positions are not suitable for children unless otherwise noted. COVID-19 safety precautions and protocols are observed at all times. For any questions or to request a paper application, please email Sierra Partlan, Director of Development and Programs, at spartlan@pettengillhouse.org
Contact Information
Name: *

First Name Last Name
Birth Date *

Month Day Year
Cell Phone Number:

Area Code Phone Number
Home Phone Number:

Area Code Phone Number
E-mail Address: *
example@example.com
Address: *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Do you know any staff members or volunteers associated with Pettengill House?

No Yes (please list below)
If yes, please give their name(s):
Emergency Contact
Name of Emergency Contact:

First Name Last Name
Phone Number

Area Code Phone Number
Relationship to You
Work & Volunteer Experience
Please briefly describe your current and/or previous work and/or volunteer experience: *
Please list any academic degrees, certifications, and/or special training you have received:
Are you currently a student?

Yes No
Name of school & year of graduation
Course of study
Are you required to complete community service hours? *

No Yes, for school Yes, court mandated Yes, other
How many hours do you need to complete?
Deadline for completing your community service hours:

Month Day Year
Date
Community service hours reporting contact info (if court mandated, please include which court system):
Please list any languages you speak fluently other than English:

Please rate your comfort level with using computers:

	1	2	3	4	5

1 is Not comfortable at all, 5 is Very comfortable

Additional comments about work/volunteer experience or special skills:
Availability

Please note that the majority of our volunteer opportunities occur on weekdays during business hours.
Days/times you would be available to volunteer (select all that apply):

Monday mornings Monday afternoons Tuesday mornings Tuesday afternoons Wednesday mornings Wednesday afternoons Thursday mornings Thursday afternoons Friday mornings Friday afternoons Weekends
Are you interested in committing to a weekly volunteer shift?

Yes No Maybe
Do you own a truck or large vehicle you can use for volunteer work?

Yes No
Additional comments about availability:
Areas of Interest

The Pettengill House has many various needs and projects throughout the year which require the assistance of volunteers. We have a limited number of regular recurring volunteer shifts in our food pantry. Please indicate your interests below, and let us know if you have any other particular ideas for how you would like to help.
Food Pantry (year-round)

Filling food orders & restocking shelves Client greetings/check-ins (must be very comfortable with computers and data entry) Receiving & unloading deliveries (some heavy lifting required) Delivering food to clients' homes
Coat Drive (Oct./Nov.)

Receiving coat donations, sorting and organizing coats Distributing coats to clients
Thanksgiving

Preparing Thanksgiving supplies for distribution Distributing Thanksgiving groceries to clients Delivering Thanksgiving groceries to clients' homes (must use your own vehicle) Receiving holiday food drive deliveries Oct. through Dec. (some heavy lifting required)
Operation Backpack (summer)

Sorting/prepping backpacks and school supplies Bin drop-offs/donation pickups at local businesses (must use your own vehicle) Distributing backpacks and supplies to clients
Saturday Night Meal Program (once a month, September-June)

Preparation and delivery of a meal to clients' homes (must use your own vehicle)
If you have a skill or interest you would like to share, or your own idea for volunteering at Pettengill House, please describe below:
Certification & Confidentiality
CERTIFICATION AGREEMENT *

I, the undersigned, certify that the facts contained in this application are true and complete to the best of my knowledge, and I understand that falsified statements made on this application may be grounds for disqualification. I authorize the Pettengill House to investigate all statements contained in this application. I hereby understand and acknowledge that unless otherwise defined by applicable law, participation in The Pettengill House Volunteer Program will be on an “at will” nature, which means that I may resign at any time and The Pettengill House may discharge me at any time for any reason.
CONFIDENTIALITY AGREEMENT *

I, the undersigned, certify that as a volunteer of The Pettengill House, Inc. I understand that any information (written, verbal or other form) obtained during the performance of my duties must remain confidential. This includes all information about members, clients, families, employees, and other associate organizations, as well as any other information otherwise marked or known to be confidential. I understand that any unauthorized release of this confidential information is considered a breach of the duty to maintain confidentiality. I further understand that any breach of the duty to maintain confidentiality could be grounds for immediate dismissal and/or possible liability in any legal action arising from such breach.
Applicant Signature *

Clear
Today's Date *

Month Day Year
Date
Should be Empty:

Pettengill House Volunteer Application

Availability

Areas of Interest

Certification & Confidentiality