St. Luke Lutheran Community : VOLUNTEER : Volunteer Application

Please fill out and submit the on-line form below or contact Cheryl Smith at (330) 497-6145 to begin your rewarding experience at St. Luke Lutheran Community!

Date:

Last Name:

First Name:

Address:

City:

State:

Zip:

Home Telephone:

Cell phone:

Email:

Preferred Response:

	Email
	Home Phone
	Cell Phone
	Mail

Emergency Contact:

Emergency Phone:

Education (If currently enrolled, please state grade.)

Highest Education Completed

Elementary:

High School:

College:

Degree:

Foreign Language Training:

Read:

	Yes
	No

Speak:

	Yes
	No

Work Experience

Employer (Name, Address, and Telephone):

From:

To:

Position:

Duties/Responsibilities:

Volunteer Experience

Organization:

Address:

City:

State:

Zip:

From:

To:

Duties/Responsibilities:

Other

Professional, trade or civic activities or offices held:

( You may want to exclude membership which would reveal gender, sex, religion, origin, age, ancestry, disablity or other protected status.)

Describe any specialized training, apprenticeship, skills, and extra-curricular activities:

I want to become a volunteer at St. Luke Lutheran Community because:

Volunteer Scheduling Preferences

Volunteer Interests:

I prefer routinely scheduled hours:

	Yes
	No

I prefer to be to be scheduled for special events only:

	Yes
	No

Hours available:

Days available:

Physical limitations :

(St. Luke Lutheran Community does not discriminate based upon limitations.)

Volunteer Signature :

(Only required if printed out and mailed in.)

Parent/Guardian Signature for those under the age of 18.

The community service for which my child has volunteered meets with my approval. I release St. Luke Lutheran Community from any liability in connection with his/her duties.

Parent/Guardian Signature:

(Only required if printed out and mailed in.)

References (Please list name and address for each)

Colored fields indicate required information.