Volunteer Opportunities Volunteer Application FormPlease enable JavaScript in your browser to complete this form.Date of Application *Name *FirstMiddleLastAddress *number, street, and apt / unit # / P.O. Box. As well as City, and Zip CodeHome #Cell #Work #Email *Date of Birth *Gender *MaleFemaleSocial Security Number (for background check purposes) *Have you ever been convicted of a felony *YesNoIf yes, please explainAre you 16 years or older? *YesNoAre you a student? *YesNoArea of StudySchoolAre you currently employed? *YesNoOccupationEmployerPosition Applying For (Check all that apply) *MentorMaintenance / CarpenterLandscaping / Yard WorkBible Study / One Day EventOtherNumber of Hours Available to Volunteer Each Week *1-55-1010-15>15Please list the time frames you are available to work/volunteer including after school/work and on weekends. *Please list days of the week and times available from start to end. i.e. Monday: Start 9:00 AM End 5:00 PM etc.List Any Previous or Current Volunteer ExperienceOrganization, Position/Major Responsibility, Dates of service (mm/yy)Why would you like to serve at the Hosea House? *How do you see your service supporting Hosea's House mission to share the love of Christ by serving those in need? *What is your faith identity? *What church/house of worship do you attend either now or have in the past?How did you hear about Hosea's House? *ReferralReferralSocial MediaMagazineNewspaperRadioOtherPlease list any community groups or professional organizations of which you have participated.Please share a little bit about yourself. What are your favorite things to do? Such as family hobbies, personal interests, etc. What brings joy to your life? *List any talents, qualifications and skills that you will bring to this position.Are there any work conditions or situations that you must avoid? Explain all.Leave blank if none apply to you.Please list two references – one personalNamePhoneOne professional NamePhoneIn case of emergency, who do we need to contact? *Primary Contact Name, best phone number to reach them and a secondary number, as well as their relation to you.Have you ever had an open case with Child Protective Services? *YesNoHave you ever been involved in sexual misconduct? *YesNoHave you experienced any impairment due to chemical dependence or substance abuse of any kind? *YesNoI give Hosea's House permission to conduct a nation-wide criminal background check, using my date of birth and social security number. *I understand that as a volunteer of Hosea's House that I am not to exchange private information such as name, address & phone number with the resident's or give any gifts or donations without the consent of Hosea's House Administrators and in doing so without authorization will terminate my rights to volunteer. *Please contact Teresa Oechsli at 502-418-3458 to discuss gifts, exchange of personal information or to make donations.As a volunteer of Hosea's House, I am aware of the resident's right to confidentiality. I realize that any information I obtain regarding any resident's of Hosea's House is to remain confidential. All resident's information is considered private and protected. I understand and agree to abide by this statement of confidentiality and attest to the accuracy of the information I have included on this form. *FirstLasteSignature/Initals *Date *Submit Pages: 1 2