ADULT VOLUNTEER APPLICATION


First Name, Middle Initial, Last Name Required

Date of Birth mm/dd/yyyy Required

Address Required

Phone Number Required

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Cell Phone Number Required

Work Phone Number Required

Email Address Required

Current Employer and Position Required

Please list the area(s) in which you'd be interested in volunteering (administrative, meals, events) Required

Are your volunteer hours required by a school, program or other entity? Required

For what school, organization or other entity is your Community Service required Required

If so, how many hours are you required to volunteer? Required

When are your required hours due? Required

Day of Week (Monday - Friday) Preferred: Required

Preferred Shift: 10:00am-1:00pm; 1:00pm-4:00pm; 4:00pm-6:00pm; (Mon-Thurs only) 6:00pm-9:00pm Required

Please list any organizations with whom you have previously volunteered: Required

Please provide the names and EITHER the E-Mail or COMPLETE REGULAR MAILING addresses of three people whom you have known for at least one year that would be willing to provide a reference for you. Do not include immediate family members or others living Required

Do you hereby pledge that you shall safeguard and treat as CONFIDENTIAL all information (whether acquired through verbal communication, written record or observation) pertaining to any resident, staff member or volunteer of RMHC of West Georgia, Inc.? Required

Do you hereby certify that all information given on this application is true and correct to the best of your knowledge, without consequential or significant omissions of any kind whatsoever? Required

Do you understand that RMHC of West Georgia, Inc. will conduct a thorough inquiry of your character to verify the data provided herein and do you agree to release from liability any person giving or receiving information in connection with this inquiry? Required

Do you understand that any falsification of information given in this application or any consequential or significant omissions therefore will be considered sufficient cause for either refusal to schedule or immediate discharge from the volunteer program Required