Brave Heart Volunteers Volunteer Application

Please fill out the following form to the best of your ability. It is important that we have accurate contact information on file so that we can contact you about the next steps in the process to becoming a volunteer with BHV.

Volunteer descriptions:

1) Companionship visiting
Could include shopping, errands, simple meal preparation, playing games, reading, transportation to appointments, light housework, minor home repairs, etc. If you are interested in becoming a companion volunteer, we will discuss any necessary duties with you in depth during your volunteer interview/orientation appointment to ensure a good fit.


2) Events and administrative assistance
Could include helping with with general office tasks (could include mailings, writing letters, office correspondence), set up and clean up for events and fundraisers, cooking and baking for events, etc.
Basic Information
First name
Your answer
Last name
Your answer
Phone (home or cell)
Your answer
Phone (work)
Your answer
Address (street)
Your answer
City
Your answer
State
Your answer
Zip Code
Your answer
Email
Your answer
Occupation
Your answer
How did you hear about Brave Heart Volunteers?
Your answer
Volunteer Preferences and Information
Please check all areas you are willing to help with:
See volunteer descriptions at the top of the page.
Placement preference
I can volunteer visit:
Please list/describe your availability (weekdays and weekends, best times)
Your answer
If available, are you willing to help on-call with short notice?
Why would you like to volunteer with Brave Heart Volunteers?
(Please briefly describe)
Your answer
Please list any skills or experiences that relate to volunteering with BHV.
(Previous volunteer experience, language skills, special interests, hobbies)
Your answer
Personal Information
Check one: I prefer
Do you smoke?
Are you allergic to any pets? Please specify:
Your answer
List any special considerations or preferences for visiting (visit location, age, gender, smoker?)
Your answer
What reservations, if any, do you have about volunteering with Brave Heart Volunteers?
Your answer
If you have been employed in the last 5 years, please list the name and address of your present and most previous employers (only list two), as well as dates employed and job title\duties
Your answer
Have you ever been convicted for violation of any laws, traffic or otherwise? If yes, please explain.
Your answer
Do you have any physical condition that may limit your volunteer activities? If yes, please explain.
Your answer
Is there anything else that you would like us to know pertaining to your volunteer experience with us?
Your answer
Emergency contact information
Emergency contact name
Your answer
Emergency contact phone number
Your answer
Emergency contact relationship
Your answer
References
References: please list two persons we may contact who are not family members and who have known you for at least one year. For example, you may include employers, teachers, religious leaders, or co-workers.
Reference 1: Name
Your answer
Reference 1: Phone Number
Your answer
Reference 1: Email
Your answer
Reference 1: Relationship
Your answer
Reference 2: Name
Your answer
Reference 2: Phone Number
Your answer
Reference 2: Email
Your answer
Reference 2: Relationship
Your answer
Electronic Signature
Electronic signature
I hereby give my consent for Brave Heart Volunteers to contact my references.
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