Volunteer Application

A-2         PERSONAL & CONFIDENTIAL
L'ARCHE MOBILE
151 SOUTH ANN STREET
MOBILE, ALABAMA 36604
Tel.: (251)438-2094
Fax:(251)438-2094 or (251)433-5835
Email: larchmob@hotmail.com    Website:  www.larchemobile.org

VOLUNTEER APPLICATION

                                                                                                                                     DATE OF APPLICATION:__________________

1.    NAME:__________________________________DATE OF BIRTH:_________________________

    STREET:________________________________PLACE OF BIRTH:__________________________

    CITY & STATE:________________________________________________ZIP:_______________
    
E-MAIL ADDRESS: _______________________________________
 
    PHONE:_______________SINGLE:_____MARRIED:_____DIVORCED:_____WIDOW________

    Do you have any physical/medical problems? Yes________ No________ 

    Briefly Describe:___________________________________________________________________

    Are you taking any medication?______If yes, what? ______________________________________

    Have you ever been treated for drug or alcohol abuse?_______________________________________

    Have you ever been convicted of a criminal offense?_________________________________________

    Closest Relative(s):__________________________________________________________________

    Referral Source:___________________________________________________________________

2.    Work Experience:
    Dates       Name & Address             Type of Employment                        Immediate Supervisor
    _____    _________________    ______________________   _______________________________ 

    _____    _________________    ______________________   _______________________________

    _____    _________________    ______________________   _______________________________

3.    Education:   Completed High School? Yes____ No____    Other:
    Dates          Name of Institutions                        Addresses                   Subjects Studied or Degree        

    ________   ___________________    _________________________   _______________________
    ________   ___________________    _________________________   _______________________

    ________   ___________________    _________________________   _______________________

4.    Please list leisure activities:___________________________________________________________

5.    Please give two personal references: Give name, address, phone, fax #, and position:

    (1)________________________  _____________________________________________________

    fax#________________     _____________________________________________________

    (2)________________________  _____________________________________________________

    fax#________________     _____________________________________________________

6.    State briefly why you wish to be a volunteer with the L'Arche community:  

    ________________________________________________________________________________

    ________________________________________________________________________________

7.    When would you like to begin?_________________________________________________________

8.    How often would you like to volunteer? __________________________________________________

9.    What activities or projects would you like to volunteer for? ____________________________________
    ________________________________________________________________________________
10.    Please ask any questions you may have or make any additional comments in the space which follows:
    _________________________________________________________________________________
    _________________________________________________________________________________

11.    Do you drive? Yes___ No___            Do you have a valid driver's license?     Yes______ No__________

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ALL OF THE ABOVE INFORMATION IS GIVEN TO THE BEST OF MY KNOWLEDGE.

___________________________________________________       ___________________________
Signature                                                                                                                              Date

Person processing application  _____________________________________         _____________________________________
                                    Date
Action taken ________________________________________________________________________________________________