Volunteer Application "*" indicates required fields Personal DataIf you have questions, please contact Katherine Shirley at (318) 221-7887, kshirley@theprovidencehouse.com.Email* Phone*Name* First Last Address* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Date of Birth* MM slash DD slash YYYY Highest Level of Education* High School Some College College Degree Other Emergency ContactName* First Last Phone*Relationship* Volunteer InformationPrevious Volunteer Experience* Specialized skills, interests, or hobbies (ex: teach, music, etc...)* Have you ever been convicted of a crime?* Yes No If yes, please explain* Are you needing to do community service? If yes, for which area? Court Ordered School Other How many hours do you need?Date to be completed MM slash DD slash YYYY Please list any languages you speak other than English. May we contact you for communication assistance with clients if needed (translating or sign language)? Yes No Please check the areas where you would like to volunteer:* Provide a Meal Donation Center (Monday-Friday, 8am - 5pm) Work with School-Age Children Host a Party, Movie Night, Craft Activity, Etc. Special Project Select AllComments When are you available to volunteer?* Weekdays Weeknights Weekends Flexible How did you hear about us? Television Social Media Website Friend or Family Member Other Community Service Agreement* As a visitor, intern, or volunteer of Providence House, I affirm that:1. I will respect the privacy of residents and staff, and hold in confidence all information obtained in the course of my time here. 2. I will maintain a professional attitude that upholds confidentiality towards individuals served, employees, and Providence House. 3. Upon completing my service, I will maintain client and employee confidentiality and will hold as confidential any information I obtained concerning Providence House. 4. I will treat Providence House employees, clients, and other volunteers with respect and concern. 5. I certify that the time noted on the sign in/sign out sheet will be an accurate account of my time worked. I will sign in upon arrival, and out when I leave. 6. I understand it is my responsibility to keep my own record of hours worked, in addition to signing in/out at Providence House. 7. If I have concerns with work or activities while at Providence House, I will take them to the Volunteer Supervisor immediately. 8. I will stay in touch with the Volunteer Supervisor and will not leave the premises without letting him/her know. 9. I will dress appropriately and be neat and clean in my appearance. I will not wear tank tops, spaghetti straps, halter tops, or tops with bare shoulders/midriffs. I will not wear miniskirts, and only wear knee length shorts if working outside. My pants will not have holes, and my shirt will have no vulgar verbiage. I understand that head scarves, wraps, or wave caps are not allowed in the common areas. I will not wear flip-flops or sandals when working in the Donations Center. If I have questions about what is appropriate, I will see the Volunteer Supervisor.Consent* I understand that Providence House reserves the right to dissolve this relationship if policies and procedures are not followed, in the best interest of our families.Signature*Date MM slash DD slash YYYY Δ
