WARM Place Volunteer Application

Name*

First Last

Email*

Home Phone*

Mobile Phone*

Preferred Method of Communication*

Phone call

Text Message

Employer*

Job Title*

Physical Address*

Street Address Address Line 2 City State ZIP Code

I have a different mailing address

Address

Street Address Address Line 2 City State ZIP Code

State*

Date of Birth*

Sex

Ethnicity

Do you have any military affiliation?*

How did you hear about us?*

Previous Experience*

Please list any current or previous work involving children, students, or vulnerable populations (impaired adults, special needs individuals, etc.)

Organization

Address

Type of Work

Start Date

End Date

Contact

Qualifications*

List any talents, vocations, preparation, or training which have equipped you to work with children, students or vulnerable populations:

References*

Please provide three (3) references including; one family member, one personal (non-family member) reference, and one professional.

One of your references must include a member of the opposite sex. (Please notify your references that an authorized staff person from The WARM Place will be contacting them)

Name

Relationship

Phone

Reference 2*

Name

Relationship

Phone

Reference 3*

Name

Relationship

Phone

The WARM Place desires to protect all children in our programs. We understand that the questions below are deeply personal, and we will safeguard your private information.

Why do you want to work with children at The WARM Place?*

Do you have a preference concerning the age group or sex of children with whom you would like to work? Why?*

What is your philosophy concerning re-direction or discipline of children?*

How do you react when you are unhappy, angry or emotional about a person or circumstance?*

Have you experienced any significant physical or emotional stresses within the past year, such as the loss of a closed loved one, extreme ill health or any emotional or physical crisis? If so, please explain.*

Have you had a major death loss within your lifetime?*

Yes

Whom did you lose?

How old were you?

Have you ever been treated for any psychiatric illness, alcohol or drug abuse?*

Yes

Please Explain

A history of treatment does not necessarily disqualify you from volunteer opportunities.

Have you ever been charged with, pleaded guilty to, or been convicted of a criminal offense, including sexual related or child abuse related offense (excluding minor traffic violations)?*

Yes

Please Explain

Availability for Volunteer Work*

Select which evenings (5:30 - 9:30pm) you are available to volunteer at The WARM Place

Monday

Tuesday

Wednesday

Thursday

Houseparent

Support Group Facilitator

Volunteer Position*

Select which volunteer position you are interested in:

Houseparent

Support Group Facilitator

Personal Information Release*

I agree to the personal information release.

Criminal Background Check*

I agree and consent to the Criminal Background Check terms.

E-Signature*

By checking this box you are signifying that all of the information provided in this application is true.

Check here to sign this form.

Phone

This field is for validation purposes and should be left unchanged.

WARM Place Volunteer Application

The WARM Place desires to protect all children in our programs. We understand that the questions below are deeply personal, and we will safeguard your private information.

Get In Touch!

EIN: 75-2220859