Harmony House Mission volunteer application

· Name: _____________________________________________________________

(First, Middle, Last)

· Date of Birth _____________________________________________________________

(01/01/2000)

· Address: _____________________________________________________________

(Street Address, City, State, Zip Code)

· Phone Number:  _____________________________________________________________

(123-456-7890)

· Email: _____________________________________________________________

(john@hotmail.com)

· Name: _____________________________________________________________

(First, Middle, Last)

· How did you hear about Harmony House Mission? _______________________________________________________________________________________________________________________________________________________________________________________

· Why do you want to help the mission by doing volunteer work? _______________________________________________________________________________________________________________________________________________________________________________________

· Have you volunteered for other organizations before? Where? _______________________________________________________________________________________________________________________________________________________________________________________

· What hours and days would you be available to volunteer? _______________________________________________________________________________________________________________________________________________________________________________________

· Do you have a preferred volunteer area?

o Serving Food.

o Cooking.

o Cleaning, janitorial.

o Greeter.

o Work in the dining room ministering to others. 

o Yard Maintenance.

o Construction, repairs, painting, etc.

o General Office.

o Social Media posting and website updates.

o Praying with others.

o Sorting Clothing.

o Other:

· Do you have a driver's license? Yes / No

· Do you have any certifications such as CPR, First Aid, etc. Please note dates of certification. _______________________________________________________________________________________________________________________________________________________________________________________

· What languages do you speak? __________________________________________________________________________________________________________________________

· Do you have any physical limitations that would prevent you from doing certain things? _______________________________________________________________________________________________________________________________________________________________________________________

· For us to maintain a safe and secure environment for our guests, we ask that you complete the Volunteer Background Check Authorization Form. Any information retrieved from such a background check will be held in strictest confidence. 

· Please provide two references we may contact regarding this application. One of these may be a personal reference. ____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

· I hereby authorize Harmony House Mission, Inc. and its designated agents and representatives to conduct a review of my background, causing a consumer report to be generated for volunteer purposes. I understand that the scope of the report is focused, primarily on any previous criminal history and will include, but is not limited to, civil and criminal history records from any justice agency in all federal, state or county jurisdictions and any other public records. I hereby release the Harmony House Mission, Inc. and its designated agents and representatives, and as well as the company performing the background check and its employees, from all liability resulting from the furnishing of this information to Harmony House Mission, Inc. I certify that the information contained in this Volunteer Background Check Authorization Form is correct to the best of my knowledge. I understand that any false statements made herein could void my consideration as a volunteer of Harmony House Mission, Inc. 

Print and complete the application. Copy and email, or bring by our office at 1817 S. A. St. Elwood, IN 46036   765-623-5992