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Volunteer Application

 


Full First Name:    
Middle Initial:    
Last Name: Birthdate:
Address: Address2:
City: State:      
Zip: Email:
Phone: Cell Phone:

What made you choose Lighthouse to do volunteer service?


Please list Any Skills, Hobbies, Work Experience, or Special training that you have. (e.g. Sign Language/Foreign Language, computer skills, finances, art, cooking, gardening, tutoring, organizational skills, etc.)


Current Occupation:


Previous volunteer work you have done:


Volunteer Preferences (Check all that Apply):
Working Directly with a staff person as an assistant
Providing service to several clients
Working On A Group Project
Doing Public Speaking, Fundraising, etc.
Doing Research, trainining or an individual project
Assisting with Events
Helping around the office in general administrative duties
Community Outreach
Child Care
Building and Grounds Maintenance
Other
 If Other, please describe:  

Is there a particular person or group with whom you are particularly interested in working? (Check all that apply)

No preference
Adults
Seniors
Teens
Children
Agency Staff
Males
Females
Donors
Are there any groups with which you would not feel comfortable working?
Yes No
Please Explain:
 
Availability:
Mornings Afternoons Evenings
Days Available:
Weekday:   Mon. Tues. Wed. Thurs. Fri.
Weekends:  Sat.
Educational Experiences
Name and Location of School
Graduate
High School:
Course of Study:
Yes  No
College/University:
Course of Study:
Yes  No
Are you attending classes now? Yes  No
 
Person to be Notified in case of emergency
Name:
Relationship:
Street Address:
City:
State:
Zip:
Day Phone:
Evening Phone:
Cell Phone:
HAVE YOU BEEN CONVICTED OF A MISDEMEANOR OR FELONY WITHIN THE LAST 10 YEARS? Yes  No
If yes, please explain (a conviction record will not necessarily be cause for disqualification).
ARE YOU VOLUNTEERING TO SATISFY COURT REQUIRED COMMUNITY SERVICE? Yes  No      Number of hours required:
If yes, please list your probation officer's name, address and phone number:


By submitting this form, I agree to the following:

I certify that the information provided is true, correct and complete to the best of my knowledge. I also acknowledge that should any information on this volunteer application prove to be false or misrepresented, my application may be rejected and I may be terminated. I also authorize Lighthouse of Oakland County and/or its subsidiaries to verify all of the information provided as allowed by law.
VOLUNTEER - OATH OF CONFIDENTIALITY
I agree to keep confidential all information pertaining to Lighthouse of Oakland County, and/or its subsidiaries, clients or other confidential information including data lists, financial numbers, client or volunteer personal information, etc. I agree not to remove files from the premises of Lighthouse of Oakland County and/or its subsidiaries or to divulge any information obtained through Lighthouse without the express written permission of Lighthouse and/or its subsidiaries. I further agree not to publish or otherwise make public any information regarding Lighthouse and/or its subsidiaries´┐Ż clients, donors, employees or volunteers in such a way that would make the person identifiable.
BACKGROUND/REFERENCE CHECK AUTHORIZATION
In order to ensure a safe working environment, I am aware that Lighthouse of Oakland County and/or its subsidiaries may conduct a criminal history background, driving record and/or reference check prior to my acceptance as a volunteer at Lighthouse of Oakland County and/or its subsidiaries. I am aware that individuals who refuse to comply with this request will not be accepted as volunteers at Lighthouse of Oakland County and/or its subsidiaries.

It is my understanding that any information obtained in the course of the background investigation will be held strictly confidential by Lighthouse. Information gathered will be used only in connection with the volunteer placement process. I hereby authorize Lighthouse of Oakland County Inc. to conduct a comprehensive review of my background, which may include information concerning my criminal, motor vehicle, and other history. I understand this authorization automatically expires 90 days from the date executed below and I have the right to revoke this authorization ay any time provided I do so in writing to Lighthouse of Oakland County Inc.
AUTHORIZATION TO RELEASE INFORMATION
I authorize Lighthouse of Oakland County, Inc. and/or its subsidiaries to obtain information in order to conduct a background and/or reference check.


How did you hear about volunteering at Lighthouse?
If Other, please explain:



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