Hope Volunteer Application Form

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Email *

Name *

Date *

YYYY

Address *

City *

State *

Zip code *

Phone number *

Email *

Date of birth *

YYYY

Have you ever been convicted of a crime? *

Yes

If yes, please explain.

Education completed: *

Area of study: *

Other training:

What is your reason for seeking to volunteer with Hope? *

Are you a Christian? *

Yes

What is the basis of your salvation? *

What is your church's name and denomination? *

What is your church's address? *

Which positions have you served in at your church? *

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. *

What special skills, talents, gifts, or personality traits would you bring to this ministry? *

Have you ever counseled a woman who was considering an abortion? *

Yes

Please explain.

Have you had any experiences relating to abortion (personal, family, friends, other)? *

Yes

Have you personally had an abortion? *

Yes

Have you ever been a victim of abuse (physical, emotional, or sexual)? *

Yes

Please explain.

Please include three references, including a pastoral reference, a professional reference, and a personal reference.

Reference 1 - please include name, email, phone, years acquainted and relationship. *

Reference 2 - please include name, email, phone, years acquainted and relationship. *

Reference 3 - please include name, email, phone, years acquainted and relationship. *

What is your availability? Split shifts are available. *

Monday: 10AM to 5PM

Tuesday: 11AM to 7PM

Wednesday: 10AM to 5PM

Friday: 10AM to 5PM

Saturday: 8AM to 1PM

Thursday: 9AM to 5PM

Tuesday: 7PM to 9 PM

Thursday: 7PM to 9PM

Required

Areas of interest for volunteering: *

Client Advocate - Peer counseling for clients facing pregnancy decisions

Administrative- Sitting at the front desk, answering phone calls, and greeting clients. Organizing donations as needed.

Medical- teach classes, patient care

Other:

Required

Please list an emergency contact, including name, relationship and phone. *

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.

Applicant signature. (Please write your name.) *

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