Pole Gems Volunteer Application

Name *

First Name Last Name

Date of Birth *

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

City State / Province

Postal / Zip Code Country

Home #

Area Code Phone Number

Cell #

Area Code Phone Number

Work #

Area Code Phone Number

Area of Interest

Outreach team Prayer team Gift bag support Fundraising Other opportunities

Are you a member of a church?

Yes No I'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?

Yes No

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?

Yes No

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 Name Last Name

Phone Number

Area Code Phone Number

E-mail

Relationship:

Reference 2

Name:

First Name Last Name

Phone Number

Area Code Phone Number

E-mail

Relationship:

Emergency Contact

Name

First Name Last Name

Phone Number

Area Code Phone 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 Name Last Name

Date

Month Day Year

Please Read and Select Button Below. *

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