Personal Information

First Name *

Last Name *

Street Address *

Address Line 2

City *

State *

Zip Code *

Phone Number *

Email Address: *

What volunteer role would you prefer? (Some level of training is required for each position)

Any volunteer working with our participants will be required to complete a background check.
*

Administrative: copies, library, filing, misc.

Customer Service: greeting at entrance, phones, etc.

Fundraising/Assist on Committees and/or at events

Facilitator: working directly with participants

Other

Availability

How often are you able to volunteer? *

Weekly

Twice a Month

Monthly

Other Other

Volunteer

Do you have any disabilities which will limit your type of service? *

Yes

If yes to the above question, Please explain...

Are you 18 years or older? *

Yes

Have you ever been convicted of a crime? *

Yes

How did you hear about this volunteering opportunity? *

Reason you are applying for volunteer work *

Please list any current or prior volunteer experiences, such as clubs, church, school projects, etc. *

Work Experience

Please list any current or prior work experiences *

Education, Special Training

Professional Licensure / Certification

References

Reference #1

Full Name

Title

Phone

Email Address

Reference #2

Full Name

Title

Phone

Email Address

Reference #3

Full Name

Title

Phone

Email Address

Miscellaneous

Please list any hobbies or special interests

I hereby agree that all information included in this application form is true and complete. I understand that incomplete applications will not be considered, and that providing false information is grounds for immediate disqualification from application process, or immediate dismissal if the falsehood is discovered after placement.

If placed, I will volunteer on a regular basis, be dependable, and honor all Lory's Place volunteer policies and guidelines. I hereby authorize present and former employers, associates, schools, credit organizations, law enforcement agencies, military organizations, and/or other persons to provide Lory's Place any information which may aid in determining my suitable volunteering.

It is clearly understood that there is no employer/employee relationship and that as a support volunteer, I am not entitled to compensation or fringe benefits of any kind for voluntary services.

By submitting this application on-line, I agree to the above written statement.

An in-person interview will be scheduled when your completed applicated is received.

Do you acknowledge this information? *

I agree