Volunteer Application

All fields marked with a * are required.

Date of Birth	*
Full Name	*
Email Address	*
Street Address	*
City	*
State	*
Zip Code	*

Contact Numbers

	Work Phone
	Home Phone
	Cell Phone
	Fax

Place of Employment
May We Contact You At Work ?	Yes No

Emergency Contact

	Name
	Phone Number
	Relationship

How did you learn about our shelter ?
Why do you want to volunteer for the Shelter ?
Do you have previous volunteer experience ?	Yes No
If yes, please list previous volunteer expierence.
Please list the strengths and or skills you will bring to the Shelter.
Do you speak a language other than English ?	Yes No
If yes, please list other languages you speak.
Do you require any special accommodations ?	Yes No
If yes, please explain:
Do you have any medical conditions that staff needs to be aware of?	Yes No
If yes, please explain:
Areas of volunteer service:	Thrift Shop Special Events Transportation Clerical Children's Services Adult Services Community Education House Maintenance Lawn/Grounds Fundraising Other
If other, please explain:

Please list the days and hours you are available to volunteer:

	Monday from to
	Tueday from to
	Wednesday from to
	Thursday from to
	Friday from to
	Saturday from to
	Sunday from to

References:

Due to the issues facing the families served by the Peace at Home Family Shelter, all potential volunteers are screened for ethical conduct, reliability and ability to handle stressful situations.

We ask that you provide at least two references (family members are unacceptable) that can speak of your professional and/or personal character.

To facilitate the speedy processing of your application, please provide complete mailing addresses.

First Reference	Name
	Address
	Contact Number
	Relationship

Second Reference	Name
	Address
	Contact Number
	Relationship

Third Reference	Name
	Address
	Contact Number
	Relationship

Release:

By submitting this form, I realize that I am giving my permission to contact the above listed individuals for information in regard to my application to participate as an Peace at Home volunteer.

Your application will be processed as quickly as possible and you will be contacted about the next volunteer training/orientation. If you have any questions regarding the application package or about additional volunteer opportunities please contact Doris or Karl Jennes at 479-442-9811 or e-mail email.