Volunteers
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First and Last Name *
DOB *
MM
/
DD
/
YYYY
Email *
Phone number *
Address *
Emergency Contact *
Are you applying for a one-time volunteer experience or a long-term volunteer experience? (Mark one) *
Required
Days Available
Time of Day
Specific Dates/Period of time available
From: ___________________ To: ____________________
How many hours a week are you available?
Preferences for Volunteer Assignment:
Other Service to provide:
Education. List, specific classes taken, degrees, licenses or certificates received that make you qualified for this volunteer position. 
Please highlight relevant workplace, volunteer and other experiences, including hobbies that qualify you for this volunteer position. Include any specific, accomplishments or skills demonstrated. 
Why are you interested in this volunteer position? What do you hope to gain as a result of this experience? 
Are you interested in volunteering remotely/electronically? 
If yes, please indicate your areas of interest:
Refuge of Hope Independent Living may use my name and images of me related to my volunteer service to be used solely for the purposes of promotional materials and public relations, including News releases, community, newsletters, and website. *
Required
Authorization and agreement by applicant *
I certified that the fax at fourth and this volunteer application are true and complete to the best of my knowledge. I understand that any false statement, omission, or misrepresentation in this application or placement. Interview may result in the rejections of my application, or discharge from the volunteer program.

I consent to having refuge of Hope independent, living Inc. complete a criminal background check prior to volunteering.



Signature of Applicant: _____________________________.   Date:_____________________

Electronic Signature required: Please type first and last name, then date.
Parental consent (for those under 18 years of age)

I give the above applicant my consent to work a a volunteer at Refuge of Hope Independent Living.  


Parent Signature: _________________________________________________          Date: ___________________________

Electronic Signature required: Please type first and last name, then date. We made need to speak with you to get verbal consent.
Disclaimer
It is the policy of the refuge of Hope Independent Living Inc. to screen all perspective volunteers. While we try to place every applicant, we reserve the rights to select applicants according to our needs and criteria.

Notice:  this is an equal opportunity program refuge of hope Independent Living Inc. does not discriminate against applicants on the basis of race, color, national origin, gender, sexual orientation, disability, age or veteran status. Accommodations are available upon request to individuals with disabilities.
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