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St. Vincent's Home Inc.

Volunteer Application

CONTACT INFORMATION

Last Name: First Name: Middle:

Street Address: City, State, Zip:

Home Phone:Cell Phone:

Work Phone: 

E-mail Address:

Birthday:

Emergency Contact

Name:    Relationship to you:

Home Phone:  Cell Phone:

Work Phone:

How did you hear about us?

 Education And Employment

Education

Name school, city, state

High School:          Yrs Completed:  Diploma:

College:                 Yrs Completed:  Major:   

Graduate School:                                  Major:   

If your volunteer service is for school credit, please fill out the following section:

School's name:      Course Title:

Address:              

Contact's name:    Phone:           

Requirement :    

Current place of employment:

Position:             How long have you worked there?

What are your regular work hours?

Experience, Interests, Skills, Motivations, & Availability

Volunteer Experience:

Hobbies & Interests:

Skills & Abilities: (musical, clerical, computer, etc.)

Do you speak, read, or write another language?   If yes, which?

Why do you want to volunteer?

What do you hope to take from your volunteer experience?

What do you hope to contribute by volunteering?

What type of volunteer work would you be willing to do? (Please prioritize your choices 1 - 12)

 Activities Assistant                                      Outing Assistant

 Anything - I'm very flexible!                      Pet Visits

 Arts and Crafts                                           Reading to the Visually Impaired

Clerical/Computer                                       Special Events

 Dining Room Beverage Server                  Transport Assistant

 One on One Visits                                      Other - Please List: 

When are you available to volunteer?

Monday     Tuesday    Wednesday   

Thursday    Friday      Saturday   

Sunday   

I understand that if accepted as a volunteer:

- I voluntarily offer my services with an understanding there will be no monetary compensation.

- I agree to conform to all policies, procedures, and regulations

- I will satisfy any health screening requirements.

- If requested, I will submit references and/or appropriate school documentation.

- I certify that the information contained in this application is correct to the best of my knowledge.

Signature:    Date: