Gateway Woods

Volunteer Application

Full Name

Email Address

Street Address

City

State

Zip

Telephone

Date of Birth

(ex: mm/dd/yyyy)

Do You Have a Valid Drivers License

Do You Have Valid Auto Insurance

In the Event of an Emergency, Please Notify

Name:

Relationship:

Phone:

Address:

Education

High School:

Years Attended:

College(s):

Years Attended:

Major:

List Your Work and Volunteer Experiences

Employer or Organization	Dates	Position/Responsibilities

Were Any of the Above Experiences with Children (explain)

List Your Skills

List Your Hobbies/Interests

Evaluate Yourself

1 = Almost Never 2 = Seldom 3 = Sometimes 4 = Often 5 = Almost Always

Personal	1	2	3	4	5
Confident
Self-motivated
Creative
Ability to Follow Guidelines
Enthusiastic
Careful in speech
Flexible
Dependable
Common sense and judgement
Critical
Domineering
Irritable
Intolerant
Argumentative
Cooperative

Please add any additional comments regarding the above self-evaluation

Affiliation with what church?

When are you available?

Have you at any time ever:

Been convicted of, or pleaded no contest to, any felony?
Yes
No

Engaged in any child molestation, exploitation, or abuse?
Yes
No

If the answer to either of these questions is, "yes," please explain in detail:

Give the reference check forms to two people who know you well and can provide a character reference for you. These could include a work supervisor, teacher/professor, church leader, relative (outside immediate family), or friend. The forms should be sent back to the Volunteer Coordinator by the references.

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Social	1	2	3	4	5
Friendly
Willing to Forgive/Apologize
Discreet to Opposite Sex
Perceptive

Emotional	1	2	3	4	5
Stable
Patient
Even-tempered

Spiritual	1	2	3	4	5
Faithful in Christian Work
Consistent
Strong Personal Witness