Volunteer

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Southside Center for Violence Prevention, Inc.

Volunteer Application



Madeline's House (Shelter)
Madeline's House Thrift Shop

Board of Directors
Madeline's Corner Thrift Store


Date

Name

Last
First
MI

Address

City
State
Zip

Phone (h)
Best time to call

Phone (w)
Best time to call

Phone (cell)
Pager

E-mail address


Employer (if applicable)

Employer

Address

City
State
Zip

Occupation
Full Time
Part Time


Education

Highest level of education completed

Degree
Field

Are you currently enrolled in school?
Yes No

If yes, where?

Major
Minor

Expected Date of Completion

Driver's License #
State

Past Volunteer Experience


Special Training or Licenses

Membership(s) in Community Organization(s)

Hobbies or Special Interests

Please list any physical limitations or special needs you have (sign language, wheel chair ramp, etc.)



SELECT THE VOLUNTEER TASK(S) THAT INTEREST YOU

Fund Raising
House & Grounds

Hotline
Thrift Store Volunteers

Public Speaking
Office Help

Daily Programs at the Shelter w/ Women
Information Booths at Fairs

Daily Programs at the Shelter w/ Children
Special Events Planning

Deliveries & Pick Ups of Donations
Serve on the Board of Directors

Other


AVAILABILITY (check all that apply)

SUN
MON
TUE
WED
THU
FRI
SAT

am pm
am pm
am pm
am pm
am pm
am pm
am pm

Have you ever been convicted of a crime?
NO YES

If yes, please explain


REFERENCES

1) Name
Phone

Address
Relationship

2) Name
Phone

Address
Relationship

3) Name
Phone

Address
Relationship