Sanctum House Volunteer Application

Name*

First Last

Home Phone*

Email*

Do you have an alternate phone number?*

Yes
No

Alternate Phone

Alternate Phone Type

Mobile
Work

Address*

Street Address City State / Province / Region ZIP / Postal Code Country

Educational Background

Please Explain Any Previous/Current Volunteer Experiences

Describe any trainings, classes, experiences, talents or skills that will help you in your volunteering role

Volunteer Opportunities of Interest*

Where do you see yourself fit in? Let us know your skill

Other, please explain

I agree to a background check*

True
False

Have you ever been convicted of, or pled no contest, to a felony or misdemeanor?*

Felony
Misdemeanor
No

Felony Charge*

State

County

Date*

Sentence and/or Fine*

Disclaimer: Eligibility will be determined by the Sanctum House staff regarding your charges

Please explain*

Misdemeanor Charge*

State

County

Date*

Sentence and/or Fine*

Disclaimer: Eligibility will be determined by the Sanctum House staff regarding your charges

Please explain*

Employment Information

Name of Employer

Job Role/Title

Length of employment

Would you like to list more employment history?

Yes
No

2nd Name of Employer

2nd Job Role/Title

2nd Length of employment

Emergency Contact Information

In the event of an emergency, please provide the name of the individual we can contact.

Name of emergency contact*

Relationship*

Phone*

Reference Information

I understand it is my responsibility to supply Sanctum House with three references prior to the start of my volunteer services. I also understand that these references will be contacted by Sanctum House.
Please provide three references:

Reference #1 Name*

Reference #1 Email*

Reference #1 Phone*

Reference #2 Name*

Reference #2 Email*

Reference #2 Phone*

Reference #3 Name*

Reference #3 Email*

Reference #3 Phone*

Confidentiality Acknowledgement

I understand that anything I hear or learn regarding individuals while volunteering at Sanctum House is confidential. By submitting this form, I acknowledge and accept that a breach of this confidentiality may result in the termination of my volunteer services with Sanctum House.

Name

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

Sanctum House needs your help.

We Need Volunteers

Employment Information

Emergency Contact Information

Reference Information

Confidentiality Acknowledgement

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