Volunteer & Intern Application
Dear Potential Volunteer or Intern:

We are delighted that you have indicated an interest in volunteering your time, gifts and talents to
Patrick Henry Family Services. There is much work to be done in so many areas as we seek to
make a difference in the lives of our children.

We are excited to help you explore which of our programs or departments would best provide an opportunity for you to utilize your skills, follow your passions and serve our community!

There are specific requirements for volunteers wishing to have contact with the children, including a
background check and an interview. There may be some additional requirements or training based
on the type of work you will be doing. Those specifics will be discussed when we meet together.

Once I receive your application, we will set up a time to meet with you and we will fill out the
appropriate background check information at that time. Please keep in mind that once we receive
your application that there will be some waiting time between an interview with you and sending
your paperwork for a background check. In some cases, the background checks can take 6 weeks
or longer. I will be staying in touch with you throughout this process and fine-tuning any volunteer
assignments during that waiting period. Should you need to talk to me or you just want to check
your status at any time, please do not hesitate to contact me.

Following your acceptance as a volunteer, training will be held along with any other specialized
training you might need depending on the area in which you will be working.

Again, we thank you for your interest and look forward to building a relationship with you. We trust
that you will pray about your potential involvement with us and we know that God has a purpose
for not only our children here at Patrick Henry, but for you as well!


If you experience any problems while completing this application or if you have any questions, please email us immediately at jarrington@patrickhenry.org

Email address *
Personal Information
First Name *
Your answer
Middle Initial *
Your answer
Last Name *
Your answer
Birthdate *
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Gender *
Residence Address (Street Number, Name, Apt. No., City, State and Zip Code) *
Your answer
Driving License # (Please include the State and the Issue Date) *
Your answer
Driving Violations: (Last five years; provide offenses and dates) If none, then enter N/A *
Your answer
Home Phone Number
Your answer
Cell Phone Number *
Your answer
Best way to contact you? *
Required
What's the best time to contact you? *
Your answer
Your Occupation *
Your answer
Your Areas of Expertise *
Your answer
Your Hobbies *
Your answer
Your Interests *
Your answer
How many hours are you willing to volunteer at PHFS? *
Are you currently employed? *
Required
Start Date of Recent Employment *
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DD
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YYYY
Recent Employment (Employer Name, Employer Address and Employer Phone Number) *
Your answer
Highest Degree Completed: *
Required
Please list all schools that you've previously attended starting with high school (School Name, Major, Graduation Date): *
Your answer
Current School (School Name, Major, Anticipated Graduation Date)
Your answer
Volunteer History #1 (Organization Name, Position, Hours per week, Start and End Date) *
Your answer
Volunteer History #2 (Organization Name, Position, Hours per week, Start and End Date)
Your answer
Volunteer History #3 (Organization Name, Position, Hours per week, Start and End Date)
Your answer
Have you ever been discharged or requested to resign from a volunteer position? (If yes, explain below). *
Your answer
Foreign Language *
Required
If you speak a foreign language, please enter it here.
Your answer
1 Emergency Contact (Name, Relation and Phone Number) *
Your answer
REFERENCES - 2 Individuals other than relatives whom you have known for five or more years (name, address, phone and years known) *
Your answer
Availability: Specify what days and times you are available to volunteer Monday-Sunday. For example: Monday: 8:30am-11:00am; 3:00pm-11:00pm *
Your answer
What is your regular mode of transportation to our site? *
Are you eligible to work in the United States? *
Will you now or in the future require visa sponsorship for volunteering with Patrick Henry Family Services? If yes, please provide the type of visa and the date of expiration? If it does not apply, please type N/A. *
Your answer
Have you ever been convicted of a felony or misdemeanor (including traffic violations and/or anything you believe was dismissed/expunged/sealed under 1203.4)? This includes any offense where you were found guilty, pleaded guilty, or pleaded nolo contendere (no contest).(You may omit a: Conviction of misdemeanor while under Penal Code 1203.45 b: Any conviction specified in Health and Safety Code 11361.5). If yes, please explain: *
Your answer
Have you ever been arrested and are you out on bail or on your own recognizance awaiting trial? If yes, please explain: *
Your answer
Have you ever had an investigation, claim or charge against you of child abuse or neglect? If yes, give details regarding the same including description of the charge, the location thereof, the agency investigating, and the outcome or finding thereof). *
Your answer
Do you use, even on an occasional basis, any illicit drugs or controlled substance without a doctor’s prescription, including marijuana? If yes, please explain: *
Your answer
Do you have any physical limitations that would impact client assistance? *
How did you hear about the opportunity? (please specify) *
Your answer
Skills and Talents-Design & Marketing (Check all that apply): *
Required
Skills and Talents-Financial (Check all that apply): *
Required
Skills and Talents-Education (Check all that apply): *
Required
Skills and Talents-Ministry (Check all that apply): *
Required
Skills and Talents-Social Media & Computers (Check all that apply): *
Required
Skills and Talents-Other (Check all that apply): *
Required
What geographic area do you prefer? (Please check all that apply) *
Required
Leisure activities, hobbies, or other interests: *
Your answer
Please describe all previous experience in dealing/working with children or area in which you are interested. *
Your answer
Please give a brief example of a challenging situation in your life (school, work, family, etc.) and how you overcame it. *
Your answer
Please write a brief outline of your Christian testimony. *
Your answer
What's your availability for the next 2 weeks to meet with our Volunteer Coordinator? *
Your answer
My signature below authorizes Patrick Henry Family Service to conduct a background investigation and authorizes release of information in connection with my application for certification as a volunteer. This investigation may include such information as criminal or civil convictions, driving records, previous employers, and educational institutions, personal references, professional references, and other appropriate sources. I waive my right of access to any such information, and without limitation hereby release the Patrick Henry Family Services and the reference source from any liability in connection with its release or use. This release includes the sources cited above and specific examples as follows: local Sheriffs or Deputies, any law enforcement personnel, information from the Central Criminal Records Exchange of either data on all criminal convictions or certification that no data on criminal convictions are maintained, information from the Virginia or other State Department or Agency of Social Services referring to Child Protective Services, and any Locality to which they may refer for release of information pertaining to any findings of child abuse or neglect investigation involving me whether or not there was any finding of abuse made. Please type your full name and the date below: *
Your answer
A copy of your responses will be emailed to the address you provided.
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