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Renewal House Volunteer Application

Personal Information

First Name

Last Name

Address

Apt #/PO Box

City

State

Zip

Home Phone

Work Phone

Email Address

Date of Birth

Place of Employment and Occupation

Emergency Contact Name

Emergency Contact Phone

How did you hear about Renewal House?

Why are you interested in volunteering with Renewal House?

Previous Volunteer Experience

Education

Hobbies, Interests, Skills

Skills & Interests

In what type of volunteer work are you interested? (check all that apply)

Choose

Working one-on-one with a resident

Working one-on-one with a child

Working in group with residents

Working in group with children

Transportation

Computer Work

Fundraising, soliciting

Twelve Step support

Physical work (clean, repair, etc.)

Research

No preference

Other

Is there any type of person you refuse to work or any type of work you refuse to do?

Availability

List all times you are available to volunteer

Monday

Tuesday

Wednesday

Thursday

Friday

Saturday

Sunday

How many hours would you like to volunteer per week?

Are there any times when you are not available?

Do you have unlimited access to a vehicle?

YesNo

Have you ever been convicted of a felony?

YesNo

If yes, please explain

Do you currently have any charges pending?

YesNo

If yes, please explain

Have you ever been accused of child abuse or child sexual abuse?

YesNo

If yes, please explain

References

Please provide the names of three (3) people you have known for at least one (1) year.

Reference 1

First Name

Last Name

Address

Apt #/PO Box

City

State

Zip

Occupation

Relationship

Reference 2

First Name

Last Name

Address

Apt #/PO Box

City

State

Zip

Occupation

Relationship

Reference 3

First Name

Last Name

Address

Apt #/PO Box

City

State

Zip

Occupation

Relationship

I hereby declare that all the information I have given on this application is accurate. I understand that Renewal House will be contacting the personal references above. I also understand that Renewal House only provides liability insurance for volunteers. Renewal House does not provide worker’s comp for volunteers. Volunteers must secure insurance for any medical/accidental claims.