Volunteer Application Form

Please complete this application form if you are interested in becoming a Little Sisters of the Poor Jeanne Jugan Center volunteer. Once you complete the form, click the Continue button at the bottom.

For more information please contact the Volunteer Coordinator at 816.761.4744 or by emailing volkansascity@littlesistersofthepoor.org

Contact Information

First name:

Last name:

Title:

Nickname:

Street 1:

Street 2:

Street 3:

City:

State:

Zip:

Home phone:

OK to call me here

Work phone:

OK to call me here

Cell phone:

OK to call me here

Demographics

You may optionally provide the following information. It is used only to help us get a better idea of the demographic make-up of our volunteers.

Date of birth:

(year optional)

Age range:

Gender:

Education:

School:

Volunteer Interest

Please list the volunteer activities you would like to particpate in. Some options may include: arts & crafts, gardening, cooking, parties and holidays, religious, fitness, games, reading groups, outings, housekeeping, friendly visits, sewing, resident assistance, dining room, driving, etc.

Availability

Please indicate the days and times you are usually available to volunteer.

Sun

Mon

Tue

Wed

Thu

Fri

Sat

From:

To:

My availability is:

From:

to:

Assignment Preference

The following volunteer assignments may currently be available. Click the assignment names to learn more about that assignment then select up to three (3) that you are most interested in.

Group or Family Volunteering

Please use this space to list additional information about volunteers or the name of your service group/troop/company.

Driver's License

Do you have valid driver's license? Please note if you have a CDL or other special license.

Emergency Contact

In the event of an emergency whom should we notify?

First name:

Last name:

Title:

Street 1:

Street 2:

Street 3:

City:

State:

Zip:

Home phone:

Work phone:

Relationship:

Employer

Please list your current or most recent employer, if applicable.

Employer name:

Title:

Street 1:

Street 2:

Street 3:

City:

State:

Zip:

Home phone:

Work phone:

Additional Information

Is there any additional information you would like to provide?

EMail

We like to keep volunteers informed of important news, schedules, and volunteer opportunities by email, however will not send you any email you prefer not to receive. Use the checkboxes below to select the kinds of email you would like to receive from us.

Volunteer Information Center

We provide an online "Volunteer Information Center" where volunteers may check their schedules, update their information, and receive messages. Please select the password you would like to use to access the online Volunteer Information Center.

Please enter a password that:

Is between 8 and 30 characters long
Contains both letters and numbers.
Contains a combination of both uppercase and lower case letters.

Password:

Confirm password:

I Agree

I understand and agree that submitting this application form does not automatically register me as a Little Sisters of the Poor Jeanne Jugan Center volunteer, and that there may be certain qualifications I must meet, including the acceptance of established volunteer policies and procedures before I may begin volunteering.

By submitting this form, I attest that the information I have provided on the form is true and accurate.

I Agree

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