Volunteer Application Apply Now Tell Us About You... Name * Street Address * Street Address 2 * City * State * AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingDistrict of Columbia ZIP Code * Email* Phone* Current Age* Education (highest level completed)* Grades 1-5Grades 6-9Grades 10-12CollegeBusinessGraduate SchoolTechnical / Vocational Work / Volunteer History Current Employer * Job Title Employer Address* Employer Phone* Availability* * Sunday Monday Tuesday Wednesday Thursday Friday Saturday Hours Available* Other Organizations Where You Have Volunteered:* Please list organization name, the dates you volunteered and a brief description of your volunteer duties. Special Skills or Talents: Interest Areas * Special Events / Holiday Events Games / Arts & Crafts Gardening / Landscaping Tutoring Facility Up-Keep Supper Clubs Food Service / Kitchen Help Why are You Applying to Volunteer at Samaritan House? * Are You Bilingual? If Yes, What Language(s)? Do you have any physical or health limitations? * Emergency Contact Information Name / Relationship * Emergency Contact Phone * References Please list 2 references – List only non-relatives and those with whom you have had a minimum two year association. Reference 1: Name * Reference 1: Relationship * Reference 1: Years Known * Reference 1: Phone Reference 2: Name Reference 2: Relationship Reference 2: Years Known Reference 2: Phone Have you ever been convicted of a felony or misdemeanor offense? * Yes No Authorization * I certify the statement and representations made in this volunteer application are true and correct, and have been given voluntarily. I authorize Samaritan House to verify my references and conduct a background check. I release Samaritan House from any liability based on the information received. I understand Samaritan House has the right to deny my application for any reason. Submit
