Volunteer Application

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					B.R.E.A.D. Ministries, Inc.
Volunteer Application

Contact Information

Name
Street Address
City ST ZIP Code
Home Phone
Work Phone
E-Mail Address


Availability
During which hours are you available for volunteer assignments?

___ Tuesday mornings          ___ Thursday mornings
___ Weekday afternoons        ___ Weekend afternoons
___ Weekday evenings          ___ Weekend evenings


Interests
Tell us in which areas you are interested in volunteering

___ Administration
___ Events
___ Fundraising
___ Deliveries
___ Volunteer coordination
___ Warehouse / Food distribution


Special Skills or Qualifications
Summarize special skills and qualifications you have acquired from employment, previous volunteer
work, or through other activities, including hobbies or sports.




                                              Page 1 of 4
Previous Volunteer Experience
Summarize your previous volunteer experience.




Person to Notify in Case of Emergency

Name
Street Address
City ST ZIP Code
Home Phone
Work Phone
E-Mail Address


References – Please list 3 references

Name
Street Address
City ST ZIP Code
Home Phone
Work Phone
E-Mail Address

Name
Street Address
City ST ZIP Code
Home Phone
Work Phone
E-Mail Address

Name
Street Address
City ST ZIP Code
Home Phone
Work Phone
E-Mail Address

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Agreement and Signature
By submitting this application, I affirm that the facts set forth in it are true and complete. I understand
that if I am accepted as a volunteer, any false statements, omissions, or other misrepresentations
made by me on this application may result in my immediate dismissal.

Name (printed)
Signature
Date


Our Policy
It is the policy of this organization to provide equal opportunities without regard to race, color, religion,
national origin, gender, sexual preference, age, or disability.

Thank you for completing this application form and for your interest in volunteering with us.




                                                Page 3 of 4
                              B.R.E.A.D. Ministries, Inc. Volunteer
           Consent/Release Form for Criminal Background Check

Full Name: ____________________________________________

Date of Birth: __________________

Address:
______________________________________________________________________

______________________________________________________________________

City State Zip

ALL cities of residence within last ten years:
______________________________________________________________________

______________________________________________________________________

Social Security Number: ______-_____-______

Driver’s License State & Number: _________________

Current Employer:
___________________________________________________________________

Employer’s Address:
__________________________________________________________________

____________________________________, ______________________

City State Zip
I, (Print Name)__________________________________________ ,authorize and give consent
for the above named organization to obtain information regarding myself. This includes the
following:
   Employment records/Employers references
   Criminal background records/information
   Driver’s license check
   Automobile insurance check
   Training/Experience
   Personal References
   Addresses

I, the undersigned, authorize this information to be obtained either in writing or via telephone in
connection with my volunteer application. Any person, firm or organization providing information
or records in accordance with this authorization is released from any and all claims of liability for
compliance. Such information will be held in confidence in accordance with the organization’s
guidelines.

Signature: _______________________________________ Date: ___________________

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Description: BREAD Ministries, Inc. Volunteer Application