Volunteer Application | Pines of Peace

General Information

Name

First Last

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Home Phone

Cell Phone

Email

Employer

Occupation

Previous Volunteer Experience

Organization

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone

Supervisor

Summarize your previous volunteer experience:

Do you have previous volunteer experience with a comfort care facility?*

Yes
No

Please indicate where you have previous volunteer experience with a comfort care facility:

Indicate any volunteer training you may have received:

Personal Reference

Name

First Last

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone

Relationship

Availability

What days are you available?

Sunday
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday

During which hours are you available for volunteer assignments?

8:00 am –12:00 pm
12:00 pm– 4:00 pm
4:00 pm– 8:00 pm
8:00 pm–midnight

Would you prefer to volunteer on a regular basis?

Once a week
2 to 3 times a week
Once a month
2 to 3 times a month
Less than once a month
As needed for special events

Or for a particular event?

Auction
Golf Tournament
Bulk mailing (capital campaign, newsletters)
Garage Sale
Craft Shows
Fundraisers

Interests

Tell us in which areas you are interested in volunteering?

Special Skills or Qualifications

Summarize special skills and qualifications you have acquired from employment, previous volunteer work, or through other activities, including hobbies or sports:

Agreement and Signature

By submitting this application, I affirm that the facts set forth in it are true and complete. 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.

Name

First Last

Signature

Date

Our Policy

It is the policy of this organization to provide equal opportunities without regard to race, color, religion, national origin, gender, sexual preference, age, or disability. Thank you for completing this application form and for your interest in volunteering with us.