Adult Volunteer Application Form
Please complete this application form if you are interested in becoming a Peace Village volunteer. Once you complete the form, click the submit button at the bottom.
Contact Information
First name:
Last name:
Title:
Choose
Dr.
Mr.
Mrs.
Ms.
Street 1:
City:
State:
Choose
IL
Zip:
Home phone:
Cell phone:
Email address:
Date of birth:
Month
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Day
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1918
*
Gender:
Choose
Female
Male
Education:
Choose
Associate degree
College degree
Doctoral degree
High school
Masters degree
Some college
Trade/Vocational school
Emergency Contact
In the event of an emergency whom should we notify?
First name:
*
Last name:
*
Street 1:
*
City:
*
State:
Choose
IL
*
Zip:
*
Home phone:
*
Cell phone:
Relationship:
Choose
Daughter
Father
Friend
Legal Guardian
Mother
Neighbor
Son
Spouse
*
Availability
Please indicate the days and times you are usually available to volunteer.
Sun
Mon
Tue
Wed
Thu
Fri
Sat
From:
7:00am
7:15am
7:30am
7:45am
8:00am
8:15am
8:30am
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9:00am
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7:00am
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To:
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11:00am
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9:30am
9:45am
10:00am
10:15am
10:30am
10:45am
11:00am
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11:30am
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9:00pm
Please explain why you are interested in volunteering at Peace Village.
Background Check
Peace village requires background checks for all of our non- resident volunteers age 18 years or older.
Have you ever been convicted of a felony? If yes, please explain.
Volunteer Interests
Please indicate any skills, talents or knowledge that you wish to share with us.
Skills:
Clerical skills
Computer/technology skills
Crafting skills
Gardening
Play musical instrument
Sewing/knitting
Speak a second language
Volunteer Agreement
I understand that Peace Village requires completion of a minimum of 12 volunteer hours in order to receive professional references or service hour letters.
I understand that I am required to complete a background check prior to beginning volunteering.
I will adhere to the required business casual dress code.
I will adhere to all conduct policies and guidelines presented in the volunteer handbook.
I will consider all information which I may hear directly or indirectly concerning a resident as confidential.
I will take any problems, criticisms or suggestions to the Volunteer Coordinator.
I will notify the Volunteer Coordinator if I am unable to be present for my shift.
I will observe the mission of Peace Village, " We love and honor our residents every day."
I understand that I am applying for an unpaid position as a volunteer with no expectation of compensation and that this application is not a contract or an offer of a volunteer position.
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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