Application for volunteer service Last Name First Name Middle Address Apt/Lot City State Zip Code Home Phone Work Phone GenderMaleFemale Best Time(s) to reach you by Phone: Email Address Are you 18 years old of age or older YesNo Birthdate Availability How often are you interested in volunteering: 2-3 times /weekWeeklyTwice a monthMonthlyOther Please mark the times you are available to volunteer Monday MorningAfternoonEvening Tuesday MorningAfternoonEvening Wednesday MorningAfternoonEvening Thursday MorningAfternoonEvening Friday MorningAfternoonEvening Saturday MorningAfternoonEvening Sunday MorningAfternoonEvening WHAT VOLUNTEER POSITION(S) ARE YOU INTERESTED IN? (Check all that apply) Visiting ResidentsHelp with BingoGardeningSewingAnimals/pet therapyBeautry shop assistantParties, Special EventsSpecial presentation for residentsReading to ResidentsBible Study/religious ServicesMusic (Singing, Play instrumentGift ShopCookingArts & CraftsPlay cards or games Others Why Are You Applying to Volunteer? Please indicate why you want to volunteer at ICMCF and what you hope to gain. EDUCATION: Are you currently in school? YesNo If yes Please list where What level of school have you completed? ElementaryHigh SchoolCollegePost Graduate Hobbies/Interest/Special Skills Please check all that apply GardeningCookingAnimalPet therapyReadingSingingCurrent EventsTravelMoviesSports Instrument played please list: Arts & Crafts, Please List: Employment History EmployedPart-timeFull-timeSelf EmployedRetired Please list most recent employer: Profession Employer Address Telephone Email Position Supervisor Have you ever volunteered or been employed by ICMCF? YesNo If yes, Indicate Position Date PERSONAL REFERENCES Please list two references other than relatives or employers: Name Daytime Phone Evening Phone How known How long Do you have any felony charges pending against you? YesNo Have you ever been convicted or pled guilty or no contest to a crime? YesNo If you answered yes to either of the two preceding questions, explain by giving date, nature of the offense and circumstances in an attached, signed statement. Conviction of a crime will not necessarily disqualify an applicant from volunteering. Are you able to perform the essential volunteer job duties of the volunteer positions for which you are applying with or without reasonable accommodation? YesNo ACKNOWLEDGEMENT On entering the captcha and clicking submit button, I will volunteer according to my schedule, be dependable, honor the right's of residents and follow all ICMCF policies and guidelines. I give permission for my employment, school and other associates to be contacted for a reference. I also understand that ICMCF will conduct a criminal background check prior to extending any offer for volunteer position.