Application – David's House

How would you like to volunteer with us?

Name*

Date of Birth*

Social Security Number (Used for background check only)

Primary Phone #*

Phone Type*

Mobile

Home

Email Address*

Home Address (Physical and Mailing)*

City, State, Zip*

Are you volunteering as part of or through a business, school group, or other organization?*

Yes

If yes, which one?

Have you ever been convicted of a crime other than a traffic violation?*

Yes

If yes, what charge?

Date convicted:

Where?

Current Employer (Name/Contact info)

Prior Volunteer Experience

How did you become interested in David's House?

Do you have any physical limitations we should be aware of?

Preferred Volunteer Opportunity

Other interests/Skills

Availability specifics, if any:

Best time of day to contact you:

Preferred Method of contact:

References (at least two with address and phone number):

Confidentiality Statement: I understand that this is an application for, and not a commitment or promise of, volunteer opportunity. I certify that I have and will provide information throughout the selection process, including on this application and in interviews with David’s House, that is true, correct and complete to the best of my knowledge. I certify that I have and will answer any question that would unfavorably affect my application for a volunteer position. I understand that information contained on my application may be verified by David’s House. I understand that misrepresentation or omissions may be cause for my immediate rejection as an applicant for a volunteer position with David’s House or my termination as a volunteer. I understand and support the mission of David’s House and agree that any information I receive, directly or indirectly, regarding any guest, will be kept in strict confidence. Breaches of confidentiality will be cause for immediate dismissal. Should such a termination occur, I understand that my obligation to protect the confidentiality of both the guests and organizational information will continue after termination of my relationship with David’s House. I agree to hold David’s House staff, directors, guests, and volunteers harmless in the event of an accident or injury sustained by me while performing my volunteer service. I agree that I will not use my vehicle to transport guests at any time for any reason. I agree to authorize a national background criminal and child abuse check with the cost to be paid by David’s House:

Yes

Signature (Typed name used as electronic signature)

Date: