Personal Information

Availability / Interest

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

Background

For Medical Volunteer Positions Only

Employer 1

Employer 2

Employer 3

Christian Testimony

References

Please list two non-family references we may contact.(Medical Volunteer Applicants please include one professional reference.)

Reference 1

Reference 2

Emergency Contacts

Contact 1

Contact 2

Applicant’s Certification and Agreement

I certify that the facts set forth in this volunteer application are true and complete to the best of my knowledge, and I authorize the pregnancy center to verify their accuracy and to obtain reference information concerning my character and capabilities. I release the pregnancy center and any person or entity providing such reference information from any and all liability relating to the provision of such information or relating to any decisions made based upon such information. I give permission to the center to conduct a criminal background check to the extent that my volunteer duties may involve direct interaction with minors. If I become a volunteer at the pregnancy center, I agree to fully adhere to its policies and rules, including those rules relating to maintaining client confidentiality. I recognize that, as a volunteer, I will serve in a different role than the employees of the pregnancy center, and I am not seeking, nor expecting to receive, any compensation or other benefits in return for any volunteer services which I may provide for this ministry.

I further certify that I have read and that I am in full agreement with the pregnancy center's Statement of Faith and Statement of Principle.