Volunteer
Application
Bridge Ministries
(Please
Print)
Rev 3/25/03
Name: __________________________________________________
Date: ______________
(Last) (First)
(Middle)
Address: __________________________
City: ___________ State: _____ Zip: __________
Mailing Address
(if different): ____________________ City: _______ State: ____ Zip:
_____
Home Phone:
(_____)_________________ Work Phone: (_____)____________________
Cell (_____)__________________________
Fax: (___)___________________________
E-Mail: ________________________________
May we call you at work? Yes ____ No ____
Birth Date:
_____/_____/_____ Are
you over 18? Yes ____ No ____
(Mo.)
(Day) (Year Optional)
Emergency
Contact:
Name: _________________________________________ Phone (___)__________________
Relationship: _____________________________________
Medical information
we should know in case of an emergency: ________________________
____________________________________________________________________________
o How did you
hear about Bridge?________________________________________________
___________________________________________________________________________
___________________________________________________________________________
o Why are you
interested in volunteering with Bridge? _______________________________
__________________________________________________________________________
__________________________________________________________________________
o Have you previously
volunteered here? Yes ____ No ____
If yes, in what position? __________________________________________________
I. Education/Employment/Volunteer
Service Background
Education
o Highest level of Education: _______________________ Major? ____________________
o Are you a current student? Yes ____ No ____ If yes, name of school:
_______________
Grade
______
Is volunteer
experience required by your program? Yes ____ No ____
If yes, please explain: ________________________________________________
Employment
o Employer (Current): __________________________ Supervisor: _________________
Position held: ________________________________ Phone:(___)_________________
Address: ___________________________ City: __________State:
____ Zip: _______
Date employed: _________
o Employer (Previous):
__________________________ Supervisor: _________________
Position held: _________________________________ Phone:(___)_______________
Address: ___________________________ City: __________
State: ____ Zip: _______
Reason for leaving: _______________________________________________________
Dates employed: From ______ to _______.
Volunteer
Experience
o Do you have other volunteer experience? Yes ____ No ____
Please describe type and amount of previous experience:
Organization: ______________________________Dates of
Service: From ____ to ____
Description of duties: ______________________________________________________
Organization:
______________________________Dates of Service: From ____ to ____
Description of duties: ______________________________________________________
o Community
affiliations: (Name & indicate type of involvement)
Clubs____________________________________________________________________
Service Organizations_______________________________________________________
Professional Organizations/Boards_____________________________________________
Church __________________________________________________________________
Other ____________________________________________________________________
II.
Skills and Interests
o What are your hobbies and/or special interests? _________________________________
________________________________________________________________________
________________________________________________________________________
o What specific skills and life experiences would you bring to Bridge
as a volunteer?
________________________________________________________________________
________________________________________________________________________
o Specialized
skills which you would like to contribute:
____ Phone calling ____ Equipment repair ____
Crafts
____ Word processing ____ Photography ____ Decorations
____ Mailings ____ Public Relations ____ Graphic
Design
____ Computer tech. ____ Writing/editing ____
Entertainment
____ Errands ____ Fundraising ____ Speaking
____ Sign Language ____ Special Events - Specify:
___________________
____ Foreign Language - Specify: ____________________________________________
____ Other - Specify: ______________________________________________________
o Do you hold any special certificates? (e.g. CPR, First Aid, Lifeguard,
Defensive
Driving). No ____ Yes ____ If yes, please indicate
the type of license and an
expiration date ____________________________________________________________
III.
Preferences in Volunteering:
o Upon reviewing our "Volunteer Opportunities, do you have
a sense of an area at Bridge
you would like to be involved in? _____________________________________________
________________________________________________________________________
o Do you have
any limitations (family commitments, health, etc.) which might affect
your volunteering? No ____ Yes ____ If yes, please
explain. ______________________
________________________________________________________________________
o Have you ever
been convicted of a criminal offense? No _____ Yes _____ If yes,
please
explain: _________________________________________________________________
o Can you make
a commitment to this program for at least a year? Yes ____ No ____
If no, please explain. ________________________________________________________
o At what times
are you interested in volunteering?
Am flexible ____ Prefer weekdays ____ Prefer evenings
____
Prefer weekends ____ Prefer days ____ Other: ____________
If you
are applying to volunteer in the “Friend-to-Friend”
or “Circle of Friends” program, please answer the following
questions:
o Is there a particular group with whom you are particularly interested?
No Preference ____ Developmentally disabled ____
Physically disabled ____
o Would you
be comfortable volunteering with someone who is: ____ deaf; ____
blind;
____ wheelchair bound; ____ non-verbal; ____ development
level much lower than their age.
o Is there any
type of disability with which you would not feel comfortable working?
No ____ Yes ____ If yes, please specify: ______________________________________
~
Are you allergic to pets? ________ Please specify: ______________________
~ Do you smoke? __________ Are you
willing to volunteer with someone who smokes? _____
o Do you have
any geographic preference as to where you do volunteer work?
No ____ Yes ____ If yes, please specify: ______________________________________
IV.
Transportation (Complete if this will be part of your volunteer
service)
o Do you drive? No ____ Yes ____
If yes, are you willing to use your automobile
for volunteer service? No ____Yes ____
(If yes, please attach a copy of your driver's
license and proof of current auto insurance,
including passenger liability.)
o If you have
had a moving violation or motor vehicle accident in the past 5 years,
please describe._______________________________________________________________
o Have you ever have had any motor vehicle license suspended or
revoked?
No ____ Yes ____ If yes, please describe: ____________________________________
_____________________________________________________________________
IV.
References and Background Checks:
o Please list three (3) people who are NOT BRIDGE STAFF or RELATED
TO YOU
who know you well that we can contact for a reference
check.
Personal References
1. Name: ________________________________
Nature of Relationship: _________________
Length of time known: ___________
Home
phone (___)______________ Work phone (___)_________________
2.
Name: ________________________________
Nature of Relationship: _________________
Length of time known: ___________
Home
phone (___)______________ Work phone (___)__________________
Employer/Supervisor
Reference (Someone you have worked with including employers
or supervisors in a paid or volunteer position. If you have never
had a supervisor, please list
an additional personal reference)
1. Name: _____________________________
Work phone (____)________________
Title _______________________________
Length of time worked together _____
Business/Organization: _______________________________________________
I certify that the information set forth in this application is
true and complete to the best of my knowledge. I understand that
if I am accepted as a volunteer, Bridge Ministries may end that
relationship, if I have made any false statements or misrepresentations
in this application. I authorize Bridge Ministries to verify all
information contained in or related to this application, including
records of law enforcement agencies, references, employment and/or
volunteer history.
I understand
that information collected during this background check will be
limited to that appropriate to helping determine my suitability
for particular types of volunteer work and that all such information
collected during the check will be kept confidential. I hereby also
extend my permission to those individuals or organizations contacted
for the purpose of this background check to give their fill and
honest evaluation of my suitability for the described volunteer
work and such other information as they deem appropriate. (Questions
asked during the reference check are available to review if you
so choose.)
Signature: ________________________________________ Date: _____________________
Thank
you for your time in completing this application!
We deeply appreciate your willingness to share yourself, your time
and talents
with the persons Bridge serves and to experience their gifts in
return.
Please
mail or fax your application to Colleen Dodson
Bridge Ministries
12356 Northup Way, Suite 103, Bellevue, WA 98005-1956
Phone: (425) 885-1006; Fax: (425) 885-3900; E-mail:
volunteer@bridgemin.org.
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