Volunteer Application Form -

* Indicates required field

Date *

Date of Service *

This application does not discriminate in securing volunteers on the basis of race, color, religious creed, national origin, sex, or ancestry; or on the basis of age against persons whose age is over 40, or on the basis of handicap or disability, and any other characteristic required by law. No question on this form is intended to secure information to be used for such discrimination.

Volunteer Needs:
Board Members
Community Garden Volunteers (call 336-617-0724)
Office Support
Summer Mornings by the Garden Program Leaders
Food Pantry Helpers
Canvassing
Community Advisory Council
Cottage Grove Neighborhood Association Resident Leaders
Food Distribution

Section I

Last Name *

First Name *

Middle Name *

Address *

Line 1

Line 2

City

State

Zip Code

Country

Phone Number (Home) *

Phone Number (Mobile) *

Phone Number (Work) *

Email *

Previous Volunteer Experience *

Employer Name *

Supervisor *

Phone Number *

What do you hope to gain from Volunteering? *

Languages Spoken *

When are you willing to volunteer? (days, times, dates) *

Date of Birth *

Social Security # *

Do you have a Valid (State) Driver’s License? *

Yes No

If yes, please enter your driver's license number *

Have you ever been convicted for violation of any laws, Traffic or Otherwise? *

Yes No

If YES, please explain *

Any physical limitations? *

Yes No

In Case of Emergency please notify:

Name *

Phone Number *

Address *

Line 1

Line 2

City

State

Zip Code

Country

References (Exclude Relatives)

Name *

Phone Number *

Name *

Phone Number *

Name *

Phone Number *

Submit

New Hope Community Development Group, Inc. Position on the Child Abuse

We make an active effort to prevent child abuse, which may include but is not limited to the following:

A background check, and reference from past employers and volunteer organizations. When practical, volunteers should not put themselves in a position in which they are alone with a single child and cannot be observed by others. Allegations or suspicions of child abuse are taken seriously and are reported to police and/or state agencies for investigation.

New Hope CDC goals for children are: (1) to help children develop to their fullest potential (2) to deliver programs in a positive environment of safety, support, and care (3) to support and strengthen the family unit.

Additional Volunteer Code of Ethics and Rules: I have been informed of New Hope Community Development Group position regarding child abuse and have read and understand that portion of my Volunteer Application and Agreement on Child Abuse.

Affirmation: I hereby affirm that my answers to questions on the application are true and correct, and that I have not knowingly withheld any fact or circumstances that would, if disclosed, affect my application unfavorably. I understand that any false information submitted in this application is cause for denial of this application or termination of my volunteer services regardless of when or how discovered; and that my service is subject to state and federal law.

I hereby give my consent to contact my references; to contact my employer, past and present; and to conduct a background check according to the state and federal law.