Please complete this application form if you are interested in becoming a Tabitha volunteer. Once you complete the form, click the submit button at the bottom.

Contact Information

First name:

Last name:

Title:

Nickname:

Street 1:

Street 2:

Street 3:

City:

State:

* Zip: *

Primary phone:

* OK to call me here

Email address:

Emergency Contact

First name:

Last name:

Primary phone:

Secondary phone:

Relationship:

Demographic Information

The following information is used only to help us get a better idea of the demographic make-up of our volunteers.

Sponsoring Organization:

Gender:

Employer (or previous)/School:

Church/Place of Worship:

Retired:

Current or retired military:

Email Preferences

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.

What kinds of email would you like to receive?

Electronic newsletters

Recruitment appeals

Schedule reminders

Volunteer Specifics

How did you hear about us?:

Reason for Volunteering:

Number of Volunteer Hours Needed:

Skills:

Background Check Information

To ensure the safety of those we serve, Tabitha conducts background checks.

Date of Birth:

Have you been convicted of a crime?:

If yes, please explain:

Social Security Number:

Full Legal Name:

Availability

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

Volunteer Acknowledgement

I hereby authorize the release of information regarding my abilities. I further release all persons and Tabitha from any and all liability resulting from the furnishings of such information. All information listed by me on this application is true and correct to the best of my knowledge. I understand that any information that is disclosed to me while volunteering at Tabitha Health Care Services is confidential. Finally, I interpret "volunteer" to mean that I have agreed to work without compensation in money. Having been accepted as a volunteer, I will follow the policies and procedures presented during the volunteer orientation.

In the event of an illness or injury that occurs during volunteer service at Tabitha Health Care Services, I authorize the provision of medical or hospital care deemed necessary, permission to the treating physician or other health care provider to employ diagnostic procedures and medical treatment deemed necessary, and all medical care units to release medical record information to Tabitha Health Care services insurance carrier in order to process claims.

Investigative Reporting Acknowledgement:

I authorize that a thorough investigation may be made in connection with my application for volunteering concerning my character, general reputation, personal characteristics, any criminal record, and driving record and mode of living, whichever may be applicable, for volunteer purposes, consistent with federal and state law.

By checking this box, I apply my electronic signature, approving the statements above:

I Agree