Volunteer Application

Our volunteers make all the difference.

Looking for an opportunity to help your neighbors? You will be amazed how a few hours in service to others can make a difference! We have a variety of volunteer opportunities and are always open to special volunteer interests. Many of our volunteer positions require background screenings, training or medical testing to protect the safety and well-being of those we serve.

Please fill out our volunteer application form and we will contact within a few business days.

"*" indicates required fields

Tell us about you…

Name*

First Last

Address*

Street Address Address Line 2 City State ZIP Code

Email*

Phone*

Current Age*

Education (highest level completed)*

Grades 1-5

Grades 6-9

Grades 10-12

College

Business

Graduate School

Technical / Vocational

Work / Volunteer History

Current Employer*

Job Title

Employer Address*

Employer Phone*

Availability*

When are you available to volunteer?

Mon

Tue

Wed

Thu

Fri

Weekends

Hours Available*

What hours are you available to volunteer?

Other organizations where you have volunteered:*

Please list organization name, the dates you volunteered and a brief description of your volunteer duties.

Please list any special skills or talents you have that you feel would benefit our organization:

Interest Areas*

Which types of volunteer opportunities interest you? (check all that apply)

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

Please explain*

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.

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Name

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