Volunteer Application

Name
First Last
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Home Phone
Cell Phone
Email
Date of Birth
MM slash DD slash YYYY
Do you have any physical limitations that should be taken into consideration when arranging volunteer assignments for you?
- Yes
- No
Education/Background
Highest Level of Education Completed
- Less than High School
- High School Graduate / GED
- Tech/Voc/Certificate Program
- Some College (not graduate)
- College Graduate
- Graduate School
Degree(s) Received/ Major Field of Study
I am currently:
- Employed
- Not Employed
- Homemaker
- Retired
- Student
Special Skills / Certifications
How did you learn of the volunteer program at The Virginia Home?
Have you ever been convicted of a criminal offense other than minor traffic violations?
- Yes
- No
Is your volunteer service required to fulfill a community service obligation?
- Yes
- No
Emergency Contact Information
Name
First Last
Releationship
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Phone
Volunteer Information
Indicate the day or days of the week and the time of day you prefer to work
I am able to commit to
- Regular, ongoing jobs (requires a 6-month commitment of at least four hours per month)e
- Part-time, ongoing jobs (requires a 3-month commitment of at least two hours per month)
- On-call and special assignments (no time commitment required, but placements are limited in this category)
If you are applying for a specific job or activity, please list it here:
Programs with which you might be interested in providing assistance
- Arts/Crafts
- Painting/Drawing
- Gardening
- Pet Therapy
- Swimming
- Gift Shop
- Ball Toss
- Shopping Trips
- Manicures
- Reading
- 1:1 Visitation
- Library
- Coffee Hour
- Games-Computer
- Outings
- Lunch Bunch
- Walks Outdoors
- Office assistant
- Computer Tutor
- Cards/Games
- Cooking
- Socials
- Write Letters
- Other
Do you have any special skills or hobbies you would like to share with us?
- Computer knowledge
- Musical instrument
- Graphic design/layout
- Creative writing
- Office/clerical skills
- Storytelling/Humor
- Newsletter editing
- Beadwork
- Reception desk
- Sewing/Needlework
- Grant writing
- Organization skills
- Retail experience
- Bulk mailings
- Photography
- Fishing
- Event planning
- Singing
- Flower arranging
- Sports
- Website design
- Carpentry
- Artistic ability
- Other
Phone
This field is for validation purposes and should be left unchanged.

Education/Background

Emergency Contact Information

Volunteer Information