Volunteer Application Form

VOLUNTEER APPLICATION FORM

For the related ministries of the Christian Reformed Church

Note: Your application is the first step in finding an appropriate place for you to serve as a volunteer. We will do our best to help you find that place. However, submitting this form does not guarantee placement, nor does it obligate you to accept an assignment if offered.

Please enter answers in appropriate box. * Required fields denoted by asterisk.

* 1. Name


First	Middle Initial	Last

2. Spouse Name
(if applicable)

3. Occupation

Present

4. Education

Degree/Diploma Obtained:
Area of Study:

5. Status

6. Date of Birth

7. Gender

8. Home Address

Street
City
State/Province
Zip/PC
Country

* 9. Email Address

10. Phone

Home	( )
Work	( )
Cell	( )
Fax	( )

11. Church Membership

Church Name
Classis or District
Street
City
State/Province
Zip/PC
Country
Phone	( )
Email

12. Alternate Residence
(if applicable)

From (date):

To (date):

Street
City
State/Province
Zip/PC
Country
Phone	( )
Email

13. Person(s) to contact in case of emergency

1.	Name
	Phone	( )
	Relationship

2.	Name
	Phone	( )
	Relationship

14. References - list two persons other than relatives and pastors

1.	Name
	Street
	City
	State/Province
	Zip/PC
	Country
	Phone	( )
	Email

2.	Name
	Street
	City
	State/Province
	Zip/PC
	Country
	Phone	( )
	Email

15. Assignment Preferences
(check all that apply)

A. North America		B. International
	Disaster Response Services*		Group Opportunity
	Group Opportunity		Tour
	Individual		Individual

* Disaster Response Services gives each volunteer a DRS shirt. If you have chosen "Disaster Response Services" as one assignment preference, please specify your shirt size.

16. If you own a recreation vehicle, would you be willing to use it to provide lodging on a site?

Yes No

17. Recruitment Information: Who/What most influenced you to apply for this volunteer work?

If "other", please specifiy:

18. Photo consent

Do you grant permission for use of any photo taken of you for CRCNA promotional activities?

yes no

19. Availability

	ONLY ONE assignment.
	Specify preferred dates:
	Several assignments.
	Specify preferred dates:
	Local ongoing assignment.
	Specify preferred times:

20. Why are you volunteering to work with this Christian organization?

21. Other: please include any additional pertinent information.

22. Experience

A. According to the following guidelines, please rank only those skills that apply to you, by entering the number in the space provided (for example, 421 Painter):

1 - Can work only with close guidance of a skilled person.
2 - Can work alone, but with some guidance.
3 - Can work confidently and independently in this area.
4 - Skilled in this area, and can guide or teach others.
5 - Am Licensed/Certified in this area or field.

401 Building Estimator

402 Home Builder/Contractor

403 Carpenter

404 Finish Carpenter

405 Carpenter Rough in/Framer

406 Bricklayer/Mason

409 Concrete Worker

412 Drywall Hanger

413 Drywall Taper

415 Electrician

417 Floor Covering Installer

418 Carpet Installer

419 Vinyl Installer

421 Painter

423 Plumber

425 Roofer

429 Heating & Cooling

430 Rapid Response/Debris Removal

433 General Assistant

434 Vehicle Maintainer

436 Mobile Home Repairer

501 Assistance to Elderly

502 Assistance to Handicapped

504 Child Care, Certified by

506 Food Prep/Baking/Cooking

507 Group Food Preparation

508 Housekeeping/Cleaning

509 Menu Planning/Purchasing

510 Social Planning

511 Needs Assessment/Door-to-Door Surveying

601 Office Support

603 Commercial Artist

604 Auto/Truck Mechanic

605 Business Manager

606 Clergy

607 Farmer, Type:

608 Heavy Equipment Operator

609 Manager/Supervisor

610 Musician

611 Nurse

612 Nurses' Aid

613 Photographer

614 Physician, Type:

615 Secretary

616 Videographer

617 Teacher

618 Truck Driver (Valid CDL)

619 Grant Writer

620 Presenter/Speaker

621 Fund Raiser

623 Researcher

624 Electronics Technician

626 Chaplain

627 Journalist

629 Engineer, Type:

630 Medical Technologist

631 Salesperson

632 Community Organizer

633 Social Worker

634 TherapistL PT/OT

638 Tour Organizer

639 Negotiator/Mediator

640 Nutritionist

641 Commodity Distribution

642 Agriculturalist

643 Overseas Work Experience, Place:

701 Accountant/Bookeeper

702 Attorney

712 Computer Programmer

713 Computer/Data Processor (Word/Excel)

714 Web Page Designer

999 Other Skill, Specify:

LANGUAGES

Code:
1 - Speak, 2 - Read, 3 - Write, 4 - Translate
910 American Sign Language
901 Spanish
902 French
Other Specify:

B. My primary interests are: (please choose skill numbers from the list above)

23.

As an image bearer of God, who desires to help my neighbors far and near to become self-sufficient in meeting their own needs, I am committed to the Christian faith and willing to support the Christian Reformed Church in North America's (CRCNA's) mission which states:

As people called by God, we gather to praise God, listen to Him and respond. We nurture each other in faith and obedience to Christ. We love and care for one another as God's people. We commit ourselves to serve and to tell others about Jesus. We pursue God's justice and peace in every area of life.

To the best of my knowledge, and recent physician's report (within the past 2 years), I am capable of performing the duties that match my skills and interests. I am emotionally stable, flexible, adaptable and creative in order to work in demanding and diverse situations. I understand this information will be shared as needed to ensure safe, appropriate assignments.

	Medical Limitations, if any (such as epilepsy, diabetes, dizziness, heart conditions, etc.). Specify:
	I am willing to have a complete physical and/or appropriate immunization as required for a specific assignment.
	I understand that funding varies from one opportunity to another. I may have to cover some or all of my own expenses.
	Police check.

By submitting this form you are agreeing with the above statements, and acknowledge that the information you have provided is true and accurate.