Coyote Hill Volunteer Application
For on-going Volunteers
Personal Information
Name: (Last, First, M.I.)
Your answer
Address: (Street Number, City, State and Zip)
Your answer
Phone Number:
Your answer
Email:
Your answer
Date of Birth: (mm/dd/yy)
Your answer
Social Security Number:
Your answer
Occupation:
Your answer
Business Phone: (if applicable)
Your answer
Emergency Contact
Name of Emergency Contact:
Your answer
Phone Number of Emergency Contact:
Your answer
Business Phone Number of Emergency Contact:
Your answer
Address of Emergency Contact: (Street Number, City, State and Zip)
Your answer
Education Background
Please fill in the name, location, number of years completed and major/degree. Write N/A if it does not apply to you.
High School:
Name, Location, Number of Years Completed, Major/Degree
Your answer
College:
Name, Location, Number of Years Completed, Major/Degree
Your answer
Business or Trade School:
Name, Location, Number of Years Completed, Major/Degree
Your answer
Professional School:
Name, Location, Number of Years Completed, Major/Degree
Your answer
Volunteer Experience
Please fill in place of work, work performed, supervisor, and date(s) of the three most recent places you have volunteered. Write N/A if this does not apply to you.
Volunteer Work:
Your answer
Volunteer Work:
Your answer
Volunteer Work:
Your answer
Briefly state your reason for entering volunteer service:
Your answer
Why did you choose Coyote Hill Christian Children's Home?
Your answer
How long do you intend to volunteer?
Your answer
How did you hear of our volunteer program?
Please list any physical limitations/health issues on type of volunteer work:
Your answer
Availability: (check all that apply)
Interests/Skills: (check all that apply)
Please only select "Intern" if you are applying for an intern position with Coyote Hill.
Have you ever participated in, or been accused, convicted or pled guilty or no contest to abuse or any sexual misconduct?
(if yes, please explain your answer below)
Explanation for "Yes" answered above. If answered "No," please type "N/A" and move on to the next question.
Your answer
Have you ever been convicted of or pled guilty or no contest to any criminal offense of any kind?
(If yes, please explain your answer below)
Explanation for "Yes" answered above. If answered "No," please type "N/A" and move on to the next question.
Your answer
Please visit this link http://coyotehill.org/wp-content/uploads/2009/06/Coyote-Hill-Volunteer-Handbook1.pdf to read the "Coyote Hill Handbook and Volunteer Duties" and check below when you have read them in their entirety.
FCSR/Background Check Instructions
As a volunteer, you are not required by law to register with the Family Care Safety Registry website. However, in our ongoing effort to exercise an abundance of caution, and to ensure the utmost protection of our residents, we require all volunteers to complete the Family Care Safety Registry.
1. Go to the Family Care Safety Registry website. http://health.mo.gov/safety/fcsr/
2. Click on “Is a person already registered?” Follow the instructions by typing in your social security number and the security text. Press the “Submit” button. If it says you are in the registry, you’re finished!
3. If you are not in the Family Care Safety Registry click on “Register Online.” It may be helpful for you to use the "Online Registration Instructions." You will need your social security number and a credit/debit card as there is a minimal fee for registration (approximately $13).
Reference
Please send the following link to someone you have known at least one year and is not a family member. Preferably this person has seen you work with children and/or works closely with you on a consistent basis.

https://docs.google.com/forms/d/e/1FAIpQLSc1PGRhtxyJgP8AA_K6Qp3dCkccH2egcIaHRxtXs5u1JbIPPg/viewform

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