Felician Village

Felician Village

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Career Opportunities
Employment | Volunteer

Volunteer Application


INDIVIDUAL INFORMATION
Name
Address
City
State
Zip
Telephone (day)
Telephone (evening)
Date of Birth
Social Security #

Emergency Contact Name
Emergency Contact Relationship
Emergency Contact Telephone
Emergency Contact Cell Phone

Have you ever been convicted of a crime? Yes No
If yes, when?
Offense
(A criminal record does not constitute an automatic bar to volunteering and will be considered only as it related to the job in question)
Have you ever been convicted of an offence which involved abusing, neglecting, or mistreating individuals? Yes No
If yes, please explain

PERSONAL OR PROFESSIONAL REFERENCES (Please list three [3] – no relatives)
Reference 1
Address
Relationship
How long known
Phone

Reference 2
Address
Relationship
How long known
Phone

Reference 3
Address
Relationship
How long known
Phone

VOLUNTEER EXPERIENCE
Organization / Type of Work / Dates of Service

VOLUNTEER PREFERENCES
How did you first learn about the Volunteer Program at Felician Village?
What times/days do you prefer to volunteer?
Briefly explain why you wish to volunteer at Felician Village and what you hope to gain from your experience.
Present or previous occupation:
Special skills or training:
Do you speak or read a foreign language? Yes No
Please specify:

VOLUNTEER HELP THAT IS NEEDED AT FELICIAN VILLAGE (check what you would be interested in)
Transporting Gift Shop Stuffing envelopes Coffee Shop One-on-one visits Bistro Assisting in group activities Bingo Helping with larger events Receptionist Assisting with bowling

SKILLS / INTERESTS (Limit to five [5] categories)
Animals Mechanical Skills Antiques Music Art/Drawing Outdoor Activities Arts/Crafts Photography Cards & Games Quilting Carpentry Skills Reading to Others Cashier Sewing Cleaning Singing	Collectibles Sports Computers Theater Cooking/Baking Woodworking Dancing Writing Entertaining Yard Work Fundraising Other Gardening Instructor History Knitting/Crocheting

I, the undersigned verify that the information in this form is true and correct to the best of my knowledge. I also hold harmless Felician Village and employees from any and all liability resulting from any personal injury received during the course of my volunteer activities. Felician Village has my permission to use my name, quotes, or photo for publicity purposes.

Villa St. Francis