Volunteer Application

Name *
Primary Phone *
Primary Phone
Address *
Birthdate *
Emergency Contact Phone Number *
Emergency Contact Phone Number
I am
My employer offers a matching donation program.
Have you volunteered with us before? *
Have you ever been asked to resign as a volunteer? *
Do you have any communicable disease?
Do you smoke?
References (2 Non-Family Members)
Reference #1 Phone
Reference #1 Phone
Reference #2 Phone *
Reference #2 Phone
Have you ever been convicted of a felony? *
Have you had a misdemeanor in the last 10 years? *
I understand that the screening process of Hart Felt Ministries, Inc., includes an application form, an interview and reference checks, along with any necessary additional checks such as driver’s license, insurance confirmation, and criminal history verification, and I give my permission for them to do so. Being charged or convicted of a felony disqualifies an applicant from volunteering. Being charged or convicted of a misdemeanor does not necessarily disqualify an applicant from volunteering, as long as it does not involve fraud, dishonesty or false statement. Failure to indicate a charge or conviction, regardless of its severity or of the amount of time that has passed, will be considered a falsification of the volunteer application. This will disqualify you from further consideration, and, if you have already begun your volunteer assignment, will be grounds for dismissal. I certify that the statements made in this volunteer application are true and correct and have been given voluntarily. I understand that this information may be disclosed to any party with legal and proper interest, and I release the agency from any liability whatsoever for supplying such information. I agree to give adequate notice (unless an emergency arises) if I am unable to perform my assignment. Click to signify that you agree to the above statements. *