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GRACE HOUSE Office Use Only EVANSVILLE Date Received:____________ TEEN CHALLENGE VOLUNTEER APPLICATION Name:___________________________________________ Date:_______________________ Address:____________________________________ ___________________________________________ Day Time Phone: ( ) __________________
Evening Phone: ( )___________________ Age:_________________________
Date of Birth:___________________________________ Soc. Security #:____________________________
Drivers License #:____________________ Do you give Grace House Teen Challenge of Evansville permission to do a background check? (If you desire to volunteer with us, we are required to check your background in order to protect the women at our facility.) Circle one: Yes No When are you available? Days Evenings Weekends What days/times would you prefer to volunteer?
________________________________________ Are there any days/times you aren’t available?________________________________________ ________________________________________ What kind of volunteer work are you interested in?__________________________________ Circle any areas that especially interest you: Cooking meals Teaching Crafts Leading Devotions Chapel Service Special Events Fundraising Office Work Mentoring Students other__________________________________ Do you have any hobbies or talents that might be useful at Grace House?_____________________________________________________________ How did you hear about Grace House?____________________________________________ Have you been employed by or volunteered at a Teen Challenge Center? Yes No If so, where? Name:____________________________________________________________ Address:__________________________________________________________ Phone:_________________________
Fax:______________________________ Director:__________________________________________________________
How long were you there?___________________________________________
What did you do there?_____________________________________________
EMPLOYMENT HISTORY: Are you currently employed? Yes No If you are, is it full-time or part-time?_____________________________________________ Current Employer’s Name:________________________________________________ Address:_____________________________________________________ ______________________________________________________
Phone #:____________________
Dates Employed:__________________
Supervisor:___________________________________________________
Reason for leaving:______________________________
______________________________________________
Previous Employer’s Name: _______________________________________________
Address:_____________________________________________________ ______________________________________________________ Phone #:____________________
Dates Employed:__________________ Supervisor:___________________________________________________
Reason for leaving:____________________________________________ _____________________________________________________________
Previous Employer’s Name:_______________________________________ Address:_____________________________________________________ _____________________________________________________
Phone #:____________________ Dates Employed:__________________ Supervisor:___________________________________________________
Reason for leaving:____________________________________________ _____________________________________________________________
Previous Employer’s Name:_______________________________________________
Address:_____________________________________________________ ______________________________________________________
Phone #:____________________ Dates Employed:__________________
Supervisor:___________________________________________________
Reason for leaving:_____________________________________________ _____________________________________________________________ EDUCATION HISTORY: High School Diploma: yes no If no, highest grade completed:_______________ College: Name__________________________________________________ Address________________________________________________________ ________________________________________________________ Degree(s)_______________________________________________________ Date Graduated______________
Other Specialized Training:_________________________________________
________________________________________________________________ ________________________________________________________________ ________________________________________________________________ ________________________________________________________________ RELIGIOUS HISTORY: How long have you been a Christian?_______________________________________ What Church do you attend?______________________________________________ Church’sAddress:__________________________________________________ ________________________________________________________________
Pastor’s Name:____________________________
Phone #_______________________ What is your belief about homosexuality? Do you believe it is a sin? __________________________________________________________________ Have you ever been involved in homosexual behavior? If so, when?__________________________________________________________________
What do you believe about the baptism in the Holy Spirit?___________________________________________________________
Do you believe in speaking in tongues?_____________________________________________ PERSONAL HISTORY: Have you ever been arrested? Yes No If Yes, when and what were the charges?_____________________________________ Were you incarcerated? Yes No If Yes, where and how long?_______________________________________________ Are you on probation? Yes No If Yes, what is your PO’s name?_____________________
Phone #:_______________ Have you ever been addicted to any form of drugs, alcohol, or cigarettes? Yes No If yes, what was your addiction(s)?_______________________________________________________ _______________________________________________________ Are you now addiction free? Yes No If yes, for how long?_____________________________________________________ If no, what is your current addiction:_______________________________________ If your addiction is cigarettes, are you willing to give up smoking? Yes No Have you ever been in a recovery program? Yes No If Yes, which one?:______________________________________________________ Are you willing to have a physical exam/ blood tests, such as HIV, Hepatitis A, B, C screening, and TB at your own expense? Yes No Why do you want to volunteer at Grace House?___________________________________________________________ ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ What would you do if something is taught at Grace House that you don’t agree with?_______________________________________________________ Please list any questions you have or concerns that you would like to be addressed during an interview.____________________________________________________ _____________________________________________________________ I testify that everything written on this application is true to the best of my knowledge. ________________________________________________________________ (Signature) (Date) Please include your personal testimony on a separate page and include a reference letter from the following individuals: 1) Your Pastor 2)A Friend Your references can send us their letters directly as well, but we must receive all references before we can continue the volunteer application process. Send your application and references to: Grace House Evansville Teen Challenge Attn: Cindy Gilbert PO BOX 2470 Evansville, IN 47728-0470 **If you have any questions, please call 812-428-8448.**
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