Mosaic Volunteer Application
We require all volunteers and interns to complete a volunteer application, attend a volunteer orientation, and pass a background check. Please complete the online application and someone from Mosaic will be in touch soon.
First Name:
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Last Name:
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Address/City/State/Zip:
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Phone
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Email:
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Date of Birth:
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Place of Employment:
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Employer's Address/City/State/ Zip:
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Level of Education Completed:
College/Graduate School Attended:
Your answer
Degree Major/Minor
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Please list any languages other that English you are fluent in:
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Will you receive educational credit for your service hours? If yes, how many hours are needed in total and by what date should they be completed?:
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How did you hear about Mosaic Family Services?
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Why do you want to volunteer/intern for Mosaic Family Services?
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Are you seeking community service hours as a result of a court issue?:
Please check the volunteer opportunities you are interested in:
Required
Have you ever been convicted of a criminal offense? If yes please state the nature of the crime(s), when and where convicted and the dispositions of the case:
Your answer
Please indicate your availability:
Include days of the week and times available
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Length of volunteer commitment:
Required
Emergency Contact
Please list someone that can be contacted in case of an emergency (include name and phone number)
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