VOLUNTEER PROGRAM APPLICATION

Please complete this application form if you are interested in becoming a Howard Brown Health volunteer.

All HBHC Volunteers are required to:

* Be at least 18 years old.

**(Parental Consent for minors under 18 required!!**

* Complete a background check.

* Attend a new volunteer orientation and any additional training that may be required for your position.

* Commit to at least 3-months for a weekday shift or 6-month for a weekend shift. Because of training, some positions might require a longer commitment.

Once you complete the form, click the continue button at the bottom.

GENERAL INFORMATION:

First name:

Last name:

Middle name:

Preferred Name:

Street 1:

Street 2:

Street 3:

City:

State:

* Zip: *

Primary Phone phone:

Email address:

Date of birth:

(year optional)

Gender:

Preferred Gender Pronoun:

How did you hear about us?:

EDUCATION:

Please list the last school you attended.

Highest Level of Education Completed:

School:

Area of Study:

EMPLOYMENT:

Please list the information on your last two employers.

Employer:

1

2

Employer Name:

Last Position Held:

Street:

City:

State:

Zip:

Primary phone:

Please list you areas of responsibilities for employer 1 and employer 2.

REFERENCES:

The volunteer department may contact up to 3 references as a part of the application process. Please list professional references and/or family members and friends.

1

2

First name:

Last name:

Relationship:

Email Address:

Primary phone:

3

First name:

Last name:

Relationship:

Email Address:

Primary phone:

VOLUNTEER POSITION OPTIONS:

Please rank your top three volunteer position choices. We will do our best to accommodate your top choice based on your availability and experience, and our needs. If we are not able to place you into a position, we will add you to our waiting list and contact you when something becomes available. Applications are kept on file for one year.

* Assignment Preference:

1st choice:

2nd choice:

3rd choice:

4th choice:

5th choice:

AVAILABILITY:

Please check the boxes below that represent your regularly available hours.

Morning: approx. 8am 1pm, Afternoon: approx. 1pm 6pm Evening: approx. 6pm- 10pm

WHY VOLUNTEER:

Have you previously VOLUNTEERED with us or been EMPLOYED by us? If not, why are you interested in volunteering with Howard Brown Health Center and the LGBTQ community? You must complete this section to be considered for the volunteer program.

PUBLIC INTERACTION:

Volunteering at Howard Brown Health Center is interactive. The main role of a HBHC volunteer is working with our visitors, staff and other volunteers. Please describe your experiences working with the public. You must complete this section to be considered for the volunteer program.

SKILLS & EXPERIENCE:

Check all boxes that apply.

EMERGENCY CONTACTS:

Please list two individuals we may contact in the event of an emergency.

1

2

First name:

Last name:

Relationship:

Primary phone:

AGREEMENT STATEMENT

I certify that the statements made in this volunteer application are true and correct, and have been given voluntarily. If the information provided in this

document is found to be untruthful, I understand that I will be released from the volunteer program. I understand that I will not be paid for my services as a volunteer, and that filling out an application for the program does not guarantee acceptance into a volunteer position.

I Agree