Volunteer Application

DATE DATE / MM / DD YYYY
POSITION DESIRED
NAME
E-MAIL ADDRESS
ADDRESS ADDRESS
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
TELEPHONE TELEPHONE - ### - ### ####
DATE OF BIRTH DATE OF BIRTH / MM / DD YYYY
DRIVERS LICENSE NUMBER
MARITAL STATUS

MARITAL STATUS SINGLE MARRIED WIDOWED DIVORCED SEPARATED REMARRIED ENGAGED
SPOUSE’S NAME
YEARS MARRIED
NUMBER OF CHILDREN
CURRENT PLACE OF EMPLOYMENT
TITLE/POSITION
WORK PHONE WORK PHONE - ### - ### ####
Can you be reached at work?

Can you be reached at work? YES NO
EDUCATION AND WORK EXPERIENCE
Do you hold a college degree(s)? If so what?
Please list any current or previous work or volunteer experience you have had.
(Include Company Name, Years Served, Address, Phone & Supervisor for each)
SPIRITUAL BACKGROUND
PLEASE SUMMARIZE YOUR SPIRITUAL HISTORY
(CHURCH AFFLIATIONS, FAITH EXPERIENCE AS RELATED TO YOUR BELIEFS)
PERSONAL REFERENCES
Give THREE references, other than spouse or family, who are qualified to speak of your spiritual experience and service.
(Include NAME, ADDRESS, CITY/STATE/ZIP, PHONE, RELATIONSHIP)
Have you ever been convicted of any offense against the law?
(You may omit minor traffic violations)

Have you ever been convicted of any offense against the law?
(You may omit minor traffic violations) YES NO
If yes, please explain.
Have you ever committed or been accused, charged or alleged to have committed any act of neglecting, abusing or molesting any children?

Have you ever committed or been accused, charged or alleged to have committed any act of neglecting, abusing or molesting any children? YES NO
If yes, please explain in detail, providing date and place of incident.
Have you abused drugs or alcohol; or been concerned that you may have a problem with alcohol, pornography or any other addictions; or has anyone ever suggested that you may have a problem with any of the above?

Have you abused drugs or alcohol; or been concerned that you may have a problem with alcohol, pornography or any other addictions; or has anyone ever suggested that you may have a problem with any of the above? YES NO
If yes, please explain.
Have you been treated for a mental disorder?

Have you been treated for a mental disorder? YES NO
If yes, please explain.
APPLICANT’S CERTIFICATION AND AGREEMENT

I hereby certify that the facts set forth in this initial application are true and complete to the best of my knowledge. I understand that discovery or falsification of any statement or significant omission of facts may prevent me from obtaining a volunteer position or may subject me to immediate dismissal from that position. I authorize Mission Missouri to verify all data given in my application and my oral interview from the personal references listed in this application. I have carefully read and do understand the above statements.

I HAVE READ AND UNDERSTAND THE STATEMENT ABOVE AND THE VOLUNTEER HANDBOOK AND AGREE TO COMPLY WITH THE STATED REQUIREMENTS AND EXPECTATIONS.
Signature of Applicant

Draw or Type

I understand this is a legal representation of my signature. Clear

Full Name

I understand this is a legal representation of my signature.
Application Date Application Date / MM / DD YYYY

Volunteer Application

EDUCATION AND WORK EXPERIENCE

SPIRITUAL BACKGROUND

PERSONAL REFERENCES

APPLICANT’S CERTIFICATION AND AGREEMENT