| Name: |
| Phone(s) |
Home: _________
Work: __________ Mobile: __________ |
| Address (full) |
Street:
City/State/Zip: |
| Congregation:
|
Birth
Month & Day: |
| Primary Language: |
E-Mail: |
| Other Languages
Spoken: |
| read: Yes
___ No ___ |
write: Yes ____ No ____ |
| Education
Level and Major field(s): |
| Special
Talents and skills: |
|
Employment Experience:
|
|
Organizational
Memberships:
|
|
Special Interests:
|
| Check the
type(s) of volunteer service you are interested in: |
__
Intake
.... Counselor |
__
Receptionist |
__
Board Member |
__
Christian Women's
.....Job Corp |
| __
Rx Counselor |
__
Pantry
.... Worker |
__
Committee
.....Member |
__
C.I.T.A. * (interpreter) |
|
I want to
volunteer (circle) ...1...2...3...4...(more)
times a month
Put me on the substitute list (circle) ...Y...N |
Please
indicate times you are available by writing:
1st, 2nd, 3rd choice below (C.I.T.A. is by appointment)
|
Hours
|
Monday
|
Tuesday
|
Wednesday
|
Thursday
|
Friday
|
|
9:00
- 11:00 AM
|
..
|
..
|
..
|
..
|
..
|
|
1:00
- 3:30 PM
|
..
|
..
|
Closed
|
..
|
Closed
|
|
|
* C.T.I.A. Volunteers
- list language classes and taken or interpretation/translation
certification received if any:
|
I have transportation
for CITA appointments ...Y
... N
I am willing to travel up to 60 miles for CITA ...Y
...N
|
|
All
Volunteers
|
The
information above is true to the best of my knowledge. I
give IMI permission to verify this information as needed.
I agree to complete all required training for the volunteer
position I accept, to abide by all guidelines and procedures
of Interfaith Ministries, to respect the confidential nature
of all records and personal contact with clients, and to
work cooperatively with staff and other volunteers. |
| Signature:
..........................................................................Date
................. |
..........Interfaith
Ministries, Inc.