Volunteer Application (one application per person)

Volunteer Application
Note: Your application is the first step in finding an appropriate place for you to serve as a volunteer. We will do our best to help you find that place. However, submitting this form does no guarantee placement, nor does it obligate you to accept an assignment. As of March 2016 people volunteering for the Christian Reformed Church of North America (CRCNA), of which World Renew is an agency, are required to complete a background check. See the last page of the application for more details.
Date

Month Day Year
Name *

First Name Last Name
Spouse's name
Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country
E-mail
Home Number

Area Code Phone Number
Cellular Number

Area Code Phone Number
Work Number

Area Code Phone Number
Work status
Occupation
Education: Degree/diploma obtained:
Area of Study
Date of Birth

Month Day Year
Gender
Shirt Size
Ethnicity (optional): may choose more than one

White Hispanic or Latino Black or African American Native American Asian/Pacific Islander Other
Church Name
Church City & State/Prov
Denomination
Church Address
Church City & State
Church Zip/PC
Who/what most influenced you to apply for this volunteer work? Select only one.
Can provide lodging, if needed
Length
Number of slides
Do you grant permission for use of any photo taken of you for promotional activities?

Yes No
I would like to receive the volunteer newsletter, the Spotlight, 3 times a year via:

Email Postal Mail
Person(s) to contact in case of emergency:
Emergency Contact #1
Relationship
Phone Number
Emergency Contact #2
Relationship
Phone Number
References: List two persons other than relatives and pastors.
Reference #1
Email
Phone
Reference #2
Email
Phone
Why are you volunteering to work with this Christian organization?
Availability: When are you able to volunteer. Specify preferred dates.
Skills & Experience

According to the following guidelines, plase rank ONLY those skills that apply to you, by selecting the number in the space provided (for example 421 Painter 3)

1 Can work only with close guidance of a skilled person

2 Can work alone, but with some guidance

3 Can work confidently and independently in this area

4 Skilled in this area and can guide or teach others

5 Am Licensed/Certified in this area or field
401 Building Estimator
402 Home Builder
403 Carpenter
404 Finish Carpenter
405 Rough-in/Framer
406 Bricklayer/Mason
409 Concrete Worker
412 Drywall Hanger
413 Drywall Taping/Mudding
414 Ceiling Texturing
415 Electrician
416 Siding Installer
418 Carpet Installer
419 Vinyl Floor Installer
420 Laminate Installer
421 Painter
422 Ceramic Tile
423 Plumber
425 Roofer
429 Heating & Cooling
430 Rapid Response/Debris Removal
433 General Assistant
434 Vehicle Maintenance
436 Mobile Home Repair
506 Food Prep/Baking/Cooking
507 Group Food Preparation
508 Housekeeping/Cleaning
511 Needs Assessment
512 Prayer Support
601 Office Support
605 Business Manager
606 Clergy
607 Farmer
608 Heavy Equipment Operator
609 Manager/Supervisor
610 Musician
611 Nurse
612 Nurses' Aide
613 Photographer
614 Physician
615 Secretary
616 Videographer
617 Teacher
618 Truck Driver (valid CDL)
619 Grant Writer
620 Presenter/Speaker
621 Fund Raiser
626 Chaplain
627 Journalist
632 Community Organizer
633 Social Worker
639 Negotiator/Mediator
701 Accountant/Bookkeeper
702 Attorney
712 Computer Programmer
713 Computer/Data Processor
Other Skills?
Languages: 1 = Speak 2 = Read 3 = Write 4 = Translate
Spanish
Other Languages?
From the list above, my primary interests are:
Please check the following boxes; indicating you agree with each statement. *

I am committed to the Christian faith and willing to support the Christian Reformed Church in North America's (CRCNA's) mission which states: "As people called by God, we gather to praise god, listen to Him and respond. We nurture each other in faith and obedience to Christ. We love and care for one another as God's people. We commit ourselves to serve and to tell others about Jesus. We pursue God's justice and peace in every area of life." To the best of my knowledge, and recent physician's report (within the past 2 years), I am capable of performing the duties that match my skills and interests. I am emotionally stable, flexible and adaptable in order to work in demanding and diverse situations. I understand this information will be shared as needed to ensure safe, appropriate assignments. I am willing to have a complete physical and/or appropriate immunizations as required for a specific assignment. I understand that funding varies from one opportunity to another, I may have to cover some or all of my own expenses. I understand that it is a policy of the CRCNA and World Renew to obtain a background check before I can volunteer. I also understand that it is my responsibility to obtain this background check and pay any costs associated with this. The cost of the background check is minimal. World Renew will send the instructions on obtaining the background check once my application has been received. I certify that the information contained in this application is true and accurate.
Limitations, if any (such as epilepsy, diabetes, dizziness, heart condition, etc)
Please check the following boxes; indicating you have read the following statements: *

US DISCLAIMER: Unless staff is notified by phone or ail, volunteers may receive future mailings for volunteer opportunities and/or CRCNA programs and campaigns. CANADIAN PRIVACY STATEMENT: The information provided by the Applicant in this form will be used to assess the suitability of the Applicant for placement in available volunteer roles and, when possible, to place volunteers in demographically appropriate roles. This information will also be used to update Christian Reformed Church constituency records, which include mailing lists pertaining to the Christian Reformed Church and its agencies/ministries. The information provided by the applicant in this form will only be used for this purposes and will not be disclosed to third parties except in furtherance of these purposes or as required by law. RELEASE OF LIABILITY: I acknowledge and understand that there are significant elements of Risk in connection with the volunteer activities that I will be performing, and that serious injuries or illness occasionally occur to persons performing these services. By signing below, I am agreeing to (i) ASSUME ALL RISKS AND (ii) WAIVE AND RELEASE ANY AND ALL CLAIMS, DEMANDS, AND CAUSES OF ACTION, INCLUDING FOR PERSONAL INJURY, ILLNESS, PAIN, SUFFERING, ECONOMIC DAMAGES AND NON-ECONOMIC DAMAGES, that I have experienced and/or migh experience in the future (whether known, unknown, anticipated, unanticipated) as a result of my participating in volunteer or services on behalf of World Renew or its partner agencies, and/or affiliates. For purposes of this waiver and release, World Renew shall include World Renew, its affiliates and their officers, directors, employees, agents, volunteers, individual clients and property owners where volunteers are housed, or where work is performed. This waiver and release apply to me and to any person who could make a claim on my behalf, including without limitation, my heirs, beneficiaries, personal representatives, and next of kin. This Agreement and this Release are governed by Michigan law. In the event that any provision is found invalid, then that provision will be automatically amended in as minimal a manner as possible to make the provision valid. This is the entire agreement and any oral or other terms are excluded. I HAVE READ THE TERMS OF THIS AGREEMENT, UNDERSTAND IT, AND ENTER INTO IT VOLUNTARILY.
Signature

Clear
Signature *
Signature date *
Signature indicating approval of parent/legal guardian of applicant is less than 18 years of age.
Should be Empty: