Volunteer Opportunities

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Volunteer Application

First Name *

Last Name *

Submit as a company

Company Name

Phone 1

Address Line 1

Address Line 2

City

State/Province

Zip/Postal Code

Country

Emergency Contact Name

Please give a name and relationship.

Emergency Contact Number

Availability

Date available to begin volunteer work.

Physical Concerns

For your safety, please list any physical conditions that we will need to be aware of (back trouble, diabetes, asthma, etc.).

Convictions

Yes

Have you ever been convicted of a crime?

Reference

Please list 2 references: 1 non-relative reference and 1 work reference, your relationship to them and their best contact information.

Genacross Affiliations

Please list any friends or relatives who are working for Genacross Lutheran Services.

Community Affiliations

Community group affiliations (clubs, councils, committees, church, etc.).

Skills/Training

Special education/training which is relevant to working with residents:

Interest

Campus Care

Home and Community Based Services

Ministry Support (corporate office)

Check all that apply.

Website

Department

Job Title

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