Please enable JavaScript in your browser to complete this form.Contact Information - Step 1 of 4This application does not discriminate in securing volunteers on the basis of race, color, religious creed, national origin, sex, or ancestry; or on the basis of age against persons whose age is over 40 or on the basis of handicap or disability and any other characteristics required by law. No question on this form is to be intended to secure information to be used for such discrimination.Please fill out the form below to begin. All information is confidential.Your name: *FirstMiddleLastYour address:Address Line 1Address Line 2CityAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeEmail address: *Phone number: *NextWhy 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? *YesNoWhat did you do as a volunteer and where? *PreviousNextInterested In? (select all that apply) *StoreClericalEventsWhat days are you available? (select all that apply) *MondayTuesdayWednesdayThursdayFridaySaturdaySundayDo you have any health related conditions that would interfere with your performance of one of our volunteer positions? *YesNoPlease explain: *PreviousNextPersonal HistoryHave you ever been convicted of any criminal offense other than parking violations? *YesNoPlease explain: *ReferencesReference 1 Name: *FirstLastRelationship: *Phone number: *Reference 2 Name: *FirstLastRelationship: *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:SignatureClear SignatureAll information is confidential.PreviousSubmit