Volunteer Form

Please fill out the form below to begin. All information is confidential.

Your name: *

First

Middle

Last

Your address:

Address Line 1

Address Line 2

City

State

Zip Code

Email address: *

Phone number: *

Why are you interested in volunteering? *

Please describe any work or personal experience you think might be relevant to our program: *

Have you previously worked as a volunteer? *

Interested In? (select all that apply) *

Do you have any health related conditions that would interfere with your performance of one of our volunteer positions? *

Have you ever been convicted of any criminal offense other than parking violations? *

Reference 1 Name: *

First

Last

Relationship: *

Phone number: *

Reference 2 Name: *

First

Last

Relationship: *

Phone number: *

Terms of Agreement *

I hereby affirm that my answers to questions on the application or true and correct, and that I have not knowingly withheld any fact or circumstances that would, if disclosed, affect my application unfavorably. I understand that any false information submitted in this application is cause for denial of this application or termination of my volunteer services regardless of when or how discovered; and that my services are subject to government regulations. I understand that in addition to state mandates, Mary and Martha house will conduct a thorough background check.

Enter your full name below:

Signature

All information is confidential.