Date:

Name:
              Last                 Middle            First

 Birth Date: (month/date)

Address:

City: State: Zip:

Telephone: Work:

Emergency Contact:

Phone:

Education: (If currenty enrolled, please state grade.)
Highest Education Completed:
Elementary:High School:
College: 
Degree:
Foreign Language Training:
Read:YesNo                Speak:YesNo

Work Experience:
Employer (Name/Address/Telephone)

Dates of Employment:
From:   To:

Position:

Duties/Responsibilities:

Volunteer Experience:

Organization Name:
Address:
City:
State: Zip:
Dates From:To:
Duties/Responsibilities:

Other:
Professional, trade or civic activities or offices held. (You may exclude membership which would reveal gender,sex, religion, national origin, age, ancestry, disability or other protected status):

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

Why do you want to become a Volunteer at St. Luke Lutheran Community?

Volunteering Scheduling Preferences:

Volunteer Interests:

Do you prefer to have routinely scheduled hours?
Yes No

OR scheduled for special events only? Yes No

Hours available:

Days available:

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

Vounteer Signature:
   (Required only if printed out and mailed in)

Date:

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

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

Parent/Guardian Signature:
 (Required only if printed out and mailed in.)

Date:

References: (Please list name and address for each.)

1.

2.