Pole Gems Volunteer Application

Pole Gems Volunteer Application
Name*

First NameLast Name
Date of Birth*

MonthDayYear
Volunteers must be 21 years or older to go on outreach. Volunteers can apply if under 21 years of age for other volunteer opportunities.
E-mail*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Home #

Area CodePhone Number
Cell #

Area CodePhone Number
Work #

Area CodePhone Number
Area of Interest

Outreach teamPrayer teamGift bag supportFundraisingOther opportunities
Are you a member of a church?

YesNoI'd love more info on finding a church
If yes, where?
How long have you been attending?
Serving

Volunteering is exciting and dynamic and it's a great way to become part of the solution and experience living life beyond yourself. Serving moves you forward in your journey to know God. Each time you freely give of your time and energy to serve another person, you are modeling servanthood. For this reason, POLE Gems places a high value on serving. If you are not currently serving in your local church, then we encourage you to contact your leadership and find out how to get involved. It's a great way to make a difference and impact others in the community.
Please list any areas you are currently volunteering in:
Passion

Please use the space below to tell us what it is that draws you to be a part of POLE Gems. Feel free to include personal experience and share what it is your hope to bring to the team.
What draws you to become part of POLE Gems:
Personal or work experience that you believe has prepared you to serve on the POLE Gems team:
Medical

Health is defined as physical and mental well-being. All applicants must be in good health and able to perform the duties involved in volunteer work. please disclose information regarding any physical or psychiatric medical condition that may impact your ability to volunteer at POLE Gems.
Name of Doctor(s)
Phone number(s)
Are you currently under a doctor's care?

YesNo
If yes, for what reason?
Is there any reason you would be unable to safely perform any of the positions for which you are applying?

YesNo
If yes, please explain:
More About You
What is your relationship with God?
What do you believe that God feels for those in the sex industry?
Describe the three main relationships in your life.
History
Have you experienced any trauma in your past that you think may be a trigger?
If yes, are you willing to share with leadership the circumstances, confidentially?
References

Pastor, Church Member, Friend or Co-Worker (please no family members)
Reference 1
Name

First NameLast Name
Phone Number

Area CodePhone Number
E-mail
Relationship:
Reference 2
Name:

First NameLast Name
Phone Number

Area CodePhone Number
E-mail
Relationship:
Emergency Contact
Name

First NameLast Name
Phone Number

Area CodePhone Number
E-mail
example@example.com
Relationship
By submitting this application, you are consenting to a criminal background check.
By printing your name below, you are electronically signing this volunteer application.
Name

First NameLast Name
Date

MonthDayYear
Please Read and Select Button Below.*

I affirm that all information provided above is true and accurate to the best of my knowledge.
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