Volunteer Application Name* First Middle Last Maiden Name Address* Street Address Address Line 2 City StateAlabamaAlaskaAmerican 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 Home PhoneCell PhoneEmail Address* SSN (required for background check)* Date of Birth* Month Day Year Occupation Employer Emergency Contact Name/Relationship* Contact Phone Number*Have you ever been convicted of a felony?* Yes No If yes, please provide date and details*What are your interests and hobbies?What other volunteer activities have you been involved in?Explain briefly why you are interested in being a volunteer with SCSMDo you have educational or life experience that you think would benefit SCSM? If so, explainWhen are you available?Weekdays Mornings Afternoons Evenings Weekends Mornings Afternoons Evenings Volunteer InformationIn what areas would you like to participate? Check all that apply. Facilitate or cofacilitate groups Lead an inspirational study Prayer intercession Help the sick/bereaved/elderly with chores Visit people in hospital, nursing home, private home, care facility, etc. Follow-up phone outreach Write letters/cards of encouragement Music ministry Community outreach and awareness (delivering marketing materials) Grant writing and research Fundraising Care café set up and/or cleanup Assist with mailings Event planning Help with special events (yard sales, festivals, Christmas event, etc.) Light housekeeping at the center Light maintenance at the center Yardwork/landscaping (mowing, trimming, weeding, mulching) Receptionist coverage Answer phones Data entry Admin projects (filing, copying, scanning) Computer projects (Excel/Word) Book reviews Other (your suggestion) Reference Information Two references required –do NOT use family membersReference Name* Phone NumberReference Email Address** Address* Street Address 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 Reference Name* Phone NumberReference Email Address* Address* Street Address 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 Certification and Signature I certify that all the information on this application is true, and I give Spiritual Care Support Ministries permission to do a background check.I am aware that if I am inactive as a volunteer for two years I will need to submit new paperwork and will be responsible for the cost of any subsequent fees for additional background checks.Type Full Name* Today's Date* MM slash DD slash YYYY NameThis field is for validation purposes and should be left unchanged. Δ
