Volunteer Application Name First Last PhoneEmail Date of Birth MM slash DD slash YYYY Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaRéunionSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Current or Former Occupation Most Recent Employer Does your employer have a match or volunteer incentive program? Yes No Is there a skill you would like to share with others at the mission?Availability(Please check all that apply.)Days Monday Tuesday Wednesday Thursday Friday Saturday Sunday (dinner) Time Morning (9am—Noon) Afternoon (1pm—4pm) Frequency Weekly Bi-Weekly Monthly Bi-Monthly Special Projects Home Church (if applicable) Pastor's Name Volunteering on a regular basis (not community service), requires a background check to be completed for serving with us. Do you consent to the information on this form being used for a background check?SignatureToday's Date MM slash DD slash YYYY Please tell us why you would like to volunteer at the Addiction Healing Center at WRM.Please share with us your hobbies, interests, certifications, church and/or other community involvement.Do you need to complete community service hours? Yes No How many? Deadline? MM slash DD slash YYYY Which organization assigned the hours? Please attach any paperwork to be completed or email it to firstname.lastname@example.org.Max. file size: 16 MB.Emergency Contact Person First Last Relationship PhonePLEASE CHECK THE AREAS IN WHICH YOU ARE MOST INTERESTEDPREFERENCE Men's Building / Program Women's Building / Program Type A: Little or No Client ContactKITCHEN Meal preparation (Sunday evening) Help serve meals Clean up Baking BUILDING MAINTENANCE Light and heavy cleaning Painting Plumbing Electrical Carpentry Heating Refrigeration Snow Plowing Other OUTDOOR WORK Agriculture expertise Lawn and Garden Carpenter Small Engine Repair TRANSPORTATION Run errands Take clients to appointments (Proof of a valid driver's license will be required.)MISCELLANEOUS Reception coverage / office (daytime hours) Holiday events Doctor Nurse Accounting Type B: Driver/HelperFOOD PROGRAM Driver for food pickup Helper for food pickup Vehicle maintenance Type C: Client/Pastoral CareEDUCATIONAL Teaching: Math, reading, etc. Life Skills GED training Job counseling/placement Certification of job skill SPIRITUAL Conduct chapel service Lead a small group Pastoral care 1:1 NA or AA sponsor DONATIONS/STORE Sort donations Sort metal scrap Sort clothing Seasonal Displays Sort Books Organize items on shelves Sort Cards/Wrap Glassware Assist with marketing Photograph items for online Enter items into digital platforms CAPTCHANameThis field is for validation purposes and should be left unchanged.