Volunteer Basic InformationName* First Last PronounsExample: She/her; he/him; xe/xemEmail* Phone*Address Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Date of Birth*Safe Haven volunteers must be over 18 years old for certain tasks. Month Day Year Who is your employer and what is your title?Is your volunteer time a requirement for a class or other community service?* Yes No Required VolunteeringNote that becuase of the shorter time-frame that comes with these types of volunteer experiences, volunteers that are completing hours for a class will not have direct client or youth contact.School/Program Name*Instructor/Supervisor's name, title, contact information*How many total hours are required?*Required completion dateVolunteer AvailabilityIn general, what time(s) would you be primarily available to volunteer? NOTE: Priority is given to those that can volunteer Monday-Friday 8am-4pm.Monday Morning (8am-noon) Afternoon (noon-4pm) Evening (4-8pm) Not Available Tuesday Morning (8am-noon) Afternoon (noon-4pm) Evening (4-8pm) Not Available Wednesday Morning (8am-noon) Afternoon (noon-4pm) Evening (4-8pm) Not Available Thursday Morning (8am-noon) Afternoon (noon-4pm) Evening (4-8pm) Not Available Friday Morning (8am-noon) Afternoon (noon-4pm) Evening (4-8pm) Not Available Saturday Morning (8am-noon) Afternoon (noon-4pm) Evening (4-8pm) Not Available Sunday Morning (8am-noon) Afternoon (noon-4pm) Evening (4-8pm) Not Available Can you commit to volunteering at a regular scheduled time?YesNoBackground, experience, knowledge, skills and interestsWhy would you like to volunteer with Safe Haven?*List any skills, training or experience you would bring to this volunteer opportunity.*Have you or an immediate member of your family received services from Safe Haven in the last 24 months?*YesNoUnsureHave you ever been convicted of a misdemeanor or a felony?* Yes No Please provide dates and nature of crime.Volunteer InterestLet us know your interest in different volunteer activities.CleaningInterestedNot InterestedI'd like to learn moreOrganizingInterestedNot InterestedI'd like to learn moreDinner ServiceInterestedNot InterestedI'd like to learn moreChild CareInterestedNot InterestedI'd like to learn moreEventInterestedNot InterestedI'd like to learn moreFundraisingInterestedNot InterestedI'd like to learn moreIf you have a special talent that you would like to share, let us know here:Reference CheckSome of our volunteer positions have the potential of client interaction, because of that, we will need some references if/when you end up volunteering in those roles.Name* First Last Relationship*Relationship*Email* Phone*Phone*Name* First Last Relationship*Email* Phone*Consent*I fully understand that misrepresentation or omission of facts called for in this application is cause for dismissal. I understand that to ensure the safety of clients, it is the policy of Safe Haven Shelter and Resource Center to complete a background and reference checks on all potential volunteers and acceptance into the volunteer program is contingent upon its satisfactory completion. I give Safe Haven Shelter and Resource Center consent/permission to contact my references.