Volunteer Application - Reflection Ministries

Name *

First

Last

Email *

Primary Phone

Date of Birth

Male / Female

Are you multi-lingual?

What languages are you fluent in?

Address

Address Line 1

Address Line 2

City

State

Zip Code

Educational Information

Highest Educational Level Completed

Year Completed

Field of study

(if applicable)

Employment Information

Current or Most Previous Employeer

Position Held

Employment Dates

From

To

Criminal History

I am not the subject of a criminal investigation. *

I do not have criminal charges pending against me. *

I have never been convicted of any criminal offense (felony or Class A or B misdemeanor) involving a juvenile/child or the direct endangerment of a juvenile/child. *

I have not been convicted of any felony offense (or an equivalent offense under the Uniform Code of Military Justice) within the past 15 years. *

I have never been convicted as a sex offender. *

I have never been convicted of a capital offense. *

If you answered "False" to any of the above, please explain below.

I agree to notify Reflection Ministries in writing within 24 hours if ANY of the above criminal history changes. *

Yes
No

Interests

Tell us which areas you are interested in. (check all that apply)

Time Commitment

Tell us about your time commitment to Reflection Ministries.

6 Months
1 Year
More Than 1 Year

Monthly availability

1 - 5 Hours
5 - 10 Hours
10 Hours or More

Some areas of the Reflection Ministries Team require at least a monthly commitment on a specific day of the week. Is that something you are able to commit to?

Yes
No

Additional Information

Why are you interested in volunteering for Reflection Ministries?

Do you have any special skills or qualifications that would be relevant to volunteering with Reflection Ministries?

Please include any professional designations and/or certifications.

How did you find out about this position?

If other

References

Provide the names of two individuals that you would like us to use as references (no family members).

Reference #1

First

Last

Email

Phone #

Reference #2

First

Last

Email

Phone #

Agreement and E-Signature

By placing my name below and submitting this application, I affirm that the facts herein are true and complete. I understand that if I am accepted as a Reflection Ministries volunteer any false statements, omissions, or other misrepresentations made on this application or references may result in my immediate dismissal. I understand that Reflection Ministries is not obligated to provide a reason for their decision in accepting or rejecting me as a volunteer.

First and Last Name *

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