Volunteer Application Name Email Address City State Zip Church Home Phone Cell Phone Employer/Occupation Phone Date of Birth (A copy of your drivers license or ID will be required, prior to volunteering.) Emergency Contact Name Emergency Contact Phone Are you volunteering with a group? Are you volunteering with a group? Yes No What is the group name? Name of the lead contact for the group Group Contact Email Group Contact Phone I am interested in working with (Check all that apply) I am interested in working with (Check all that apply) Children/Youth Elderly Volunteer Opportunities (Check all that apply) Volunteer Opportunities (Check all that apply) Preparing/Serving Meals Tutoring/Mentoring Youth Retail Assistance/Stocking Camp Projects/Outdoors Admin/Support Construction/Maintenance I am available: (Check all that apply) I am available: (Check all that apply) Monday Tuesday Wednesday Thursday Friday Sat Sun Monday Times Available Tuesday Times Available Wednesday Times Available Thursday Times Available Friday Times Available Saturday Times Available Sunday Times Available ---------------------------- Have you ever been convicted of any criminal violation of any type of sexual misconduct? Have you ever been convicted of any criminal violation of any type of sexual misconduct? Yes No Please explain: Have you ever been convicted of any criminal offense (misdemeanor or felony) in a court of law? Have you ever been convicted of any criminal offense (misdemeanor or felony) in a court of law? Yes No Please explain: Have you ever been disciplined, suspended, or terminated by an organization due to allegations of sexual misconduct or abuse? Have you ever been disciplined, suspended, or terminated by an organization due to allegations of sexual misconduct or abuse? Yes No Please explain: Name/Title Phone Name/Title Phone Name/Title Phone Are you volunteering to fulfill a Community Service hours requirement? Are you volunteering to fulfill a Community Service hours requirement? Yes No Please provide the total number of Community Service hours to complete: What is the reason Community Service hours required? What was the offense that led to the Community Service hours? When do the Community Service hours need to be completed? (mm/dd/yyyy) Please list the name and phone number for your supervisor or probation officer: Please list the county where the offense/arrest occurred. Have you volunteered or worked for South Side Mission in the past? Have you volunteered or worked for South Side Mission in the past? Yes No In what location or ministry area? Send
