Volunteer Application

Thank you for your interest in becoming a There With Care volunteer. Please print and complete the Volunteer Application that applies to your volunteer interest. If you have not already done so, please sign up for a volunteer training session here. We look forward to meeting you.Personal Information

Work Phone:

Employer/School Name:

Employer/School Address:

Employer/School City:

Employer/School State:

Employer/School Zip:

OK to Call Work?:

Employer matches donations?:

Referral Notes:

Emergency Contact Name:

Emergency Contact Phone:

Emergency Contact Relationship:

Volunteer History

Do you have volunteer experience?  Please check if yes.
If yes, please list beginning with present or most recent experience:

Name of Organization (1):

Organization (1) Address:

Your position and/or responsibilities:

Begin Date:

End Date (if applicable):

Name of Organization (2):

Organization (2) Address:

Your position and/or responsibilities:

Begin Date:

End Date:

Have you ever been asked to resign or relinquish a position (check only if answer is yes):

Reason for resignation:

What has made volunteering experiences meaningful in the past?

Reason Applying:

Do you have personal or professional experience with families facing critical illness?:

Skills/Interests:

Additional Information:

Reference and Driving Information

Please provide three non-family references
Reference (1) Name:

Reference (1) Address:

Reference (1) Phone:

Reference (1) Relationship:

Reference (2) Name:

Reference (2) Address:

Reference (2) Phone:

Reference (2) Relationship:

Reference (3) Name:

Reference (3) Address:

Reference (3) Phone:

Reference (3) Relationship:

Have you ever had your driver’s license suspended or revoked? Check only if yes:

If yes, please explain:

Have you ever been convicted of a criminal offense?  Check only if yes:

If yes, please explain:

Drugs/medication?:

Drug Use Notes:

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