Madeline's House | Volunteer

Madeline's House (Shelter)

Madeline's House Thrift Shop

Board of Directors

Madeline's Corner Thrift Store

Date

Name

Last

First

MI

Address

City

State

Zip

Phone (h)

Best time to call

Phone (w)

Best time to call

Phone (cell)

Pager

E-mail address

Employer (if applicable)

Employer

Address

City

State

Zip

Occupation

Full Time

Part Time

Education

Highest level of education completed

Degree

Field

Are you currently enrolled in school?

Yes No

If yes, where?

Major

Minor

Expected Date of Completion

Driver's License #

State

Past Volunteer Experience

Special Training or Licenses

Membership(s) in Community Organization(s)

Hobbies or Special Interests

Please list any physical limitations or special needs you have (sign language, wheel chair ramp, etc.)

SELECT THE VOLUNTEER TASK(S) THAT INTEREST YOU

Fund Raising

House & Grounds

Hotline

Thrift Store Volunteers

Public Speaking

Office Help

Daily Programs at the Shelter w/ Women

Information Booths at Fairs

Daily Programs at the Shelter w/ Children

Special Events Planning

Deliveries & Pick Ups of Donations

Serve on the Board of Directors

Other

AVAILABILITY (check all that apply)

SUN

MON

TUE

WED

THU

FRI

SAT

am pm

Have you ever been convicted of a crime?

NO YES

If yes, please explain

REFERENCES

1) Name

Phone

Address

Relationship

2) Name

Phone

Address

Relationship

3) Name

Phone

Address

Relationship

Southside Center for Violence Prevention

Volunteer Application