Request edit access
HOPE Volunteer Application Form
Name *
Your answer
Date *
MM
/
DD
/
YYYY
Address *
Your answer
City *
Your answer
State *
Your answer
Zip code *
Your answer
Phone number *
Your answer
Cell phone number
Your answer
Email *
Your answer
Date of birth *
MM
/
DD
/
YYYY
Have you ever been convicted of a crime? *
If yes, please explain.
Your answer
Education completed: *
Your answer
Area of study: *
Your answer
Other training:
Your answer
What is your reason for seeking to volunteer with Hope? *
Your answer
Are you a Christian? *
What is the basis of your salvation? *
Your answer
What is your church's name and denomination? *
Your answer
What is your church's address? *
Your answer
What is your church's pastor's name and phone number? *
Your answer
Which positions have you served in at your church? *
Your answer
This organization is a Christian pro-life ministry. We believe our faith in Jesus Christ empowers us, enables us, and motivates us to provide life-giving services in this community. Please write a brief statement about how your faith would affect your volunteer work at this center. *
Your answer
What special skills, talents, gifts, or personality traits would you bring to this ministry? *
Your answer
Have you ever counseled a woman who was considering an abortion? *
Please explain.
Your answer
Have you had any experiences relating to abortion (personal, family, friends, other)? *
Have you personally had an abortion? *
Have you ever been a victim of abuse (physical, emotional, or sexual)? *
Please explain.
Your answer
Are you currently under the care of a psychiatrist or psychologist? *
Are you currently taking any medications (e.g., antidepressants or mood stabilizers)? *
Your answer
If so, what are you taking and for how long?
Your answer
Please include four references, including your pastor, a professional reference, and two personal references.
Reference 1 - please include name, email, phone, years acquainted and relationship. *
Your answer
Reference 2 - please include name, email, phone, years acquainted and relationship. *
Your answer
Reference 3 - please include name, email, phone, years acquainted and relationship. *
Your answer
Reference 4 - please include name, email, phone, years acquainted and relationship. *
Your answer
What is your availability? Note that split shifts are also available. *
Required
Areas of interest for volunteering: *
Required
Please list an emergency contact, including name, relationship and phone. *
Your answer
Applicant's certification and agreement

I certify that the facts set forth in this volunteer application are true and complete to the best of my knowledge, and I authorize HOPE IN NORTHERN VIRGINIA to verify their accuracy and to obtain reference information concerning my character and capabilities. I release HOPE IN NORTHERN VIRGINIA and any person or entity providing such reference information from any and all liability relating to the provision of such information or relating to any decisions made based upon such information. I give permission to the center to conduct a criminal background check to the extent that my volunteer duties may involve direct interaction with minors. If I become a volunteer HOPE IN NORTHERN VIRGINIA, I agree to fully adhere to its policies and rules, including those rules relating to maintaining client confidentiality. I understand that a volunteer will serve in a different capacity than the employees of HOPE IN NORTHERN VIRGINIA, and that a volunteer position will not receive compensation in return for any volunteer services.

I further certify that I have read and am in full agreement with the HOPE IN NORTHERN VIRGINIA statement of faith and code of conduct.

Applicant signature. (Please write your name.) *
Your answer
Next
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service