Loaves and Fishes Volunteer Form

Thank you for your interest in helping Loaves and Fishes children.

We ask that you fill out an application to share background information with us and indicate your preference of volunteer activities. You can complete and mail our print form, or submit the following secure online form (please complete all five sections):

Section 1: General Information

Name:
Address (incl. zip):
Phone:	Enter as (xxx) xxx-xxxx.
e-mail:
Marital status?	Single  Married
Do you have children?	Yes No
If yes, what are their ages?	For ex: 5&7&11.
Your date of birth:	Enter as mm/dd/yyyy.

Section 2: References

(Please do not list family members as references.)

1.   Name:		Relationship:
Address:		Phone:
2.   Name:		Relationship:
Address:		Phone:
3.   Name:		Relationship:
Address:		Phone:
If you are volunteering through a faith community, school, civic organization or other entity, please share that with us.
Organization:

Section 3: Education

High school:		Years completed:	4 3 2 1
Address:
Vocational school / College:		Degree:	Select-- Associate's Bachelor's Other degree In progress
Address:
Graduate school:		Degree:	Select-- Master's Doctorate Other degree In-progress Mst. In-progress Dct.
Address:

Section 4: Employment History

1. Employer (current):		Supervisor:
Job title:		Year hired:
Address:		Phone:
2. Employer:		Supervisor:
Job title:		Years worked:
Address:		Phone:
Reason for leaving:
3. Employer:		Supervisor:
Job title:		Years worked:
Address:		Phone:
Reason for leaving:

Section 5: Volunteer Interests

Select the volunteer opportunities that interest you and suit your schedule. (Keep in mind that tutoring and assisting with enrichment activities entail a weekly time commitment of 1-2 hours.)

	Tutor after school.
	Assist with after-school enrichment activities (or teach one).
	Be a guest speaker for students after school.
	Give a presentation or workshop on Family Night.
	Help with a day trip or community service project.
	Provide food for after-school snacks or Family Night.
	Help in the office with mailings and other administrative tasks.
Please tell us your area of expertise if you'd like to tutor in a particular subject, teach an enrichment activity, be a guest speaker for the children or present to the adults on Family Night:
Have you done previous volunteer work with children? Yes No
If yes, please tell us the ages of the children, the name of the organization and the type of experience:
Please check this box to certify your application.	Application Certification: By checking the box above, I certify that the information I have provided is correct to the best of my knowledge. I authorize Loaves and Fishes to verify information, make additional reference checks as necessary and conduct a criminal background check through the City/County Bureau of Identification (CCBI).
	To protect your privacy, we encrypt your information before transmitting it over the Internet.

Loaves and Fishes Ministry, Inc. © 2010