VOLUNTEER APPLICATION

Volunteer Area*

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Personal Information:

Name*

Phone*

Email*

Address*

City*

State/Region*

Zip/Postal Code*

Country

Gender*
MaleFemale

Valid Driver's License*

Date of Birth*

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Church Affiliation

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Physical Limitations related to the
volunteer area mentioned above?
YesNo
If Yes, please explain

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Insurance to cover International travel?
YesNo

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Have you ever been convicted (found guilty) of a crime or are there any pending criminal charges awaiting a hearing in a court of law?
YesNo
Please explain

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Education:

Highest level completed:
—Please choose an option—High SchoolCollegeGraduateBusinessTechnical/Vocational

School

City & State

Study Focus

School

City & State

Study Focus

School

City & State

Study Focus

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Work/Occupation:

(List below last three employers, starting with current one first)

Employer

Dates of Service

Type of Work

Employer

Dates of Service

Type of Work

Employer

Dates of Service

Type of Work

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List Certifications:

(Please give name, certification date, expiration date)

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List Previous Volunteer Experience:

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Skills:

(List your skills and indicate proficiency level)

Skill

Proficiency Level
Basic KnowledgeNeed SupervisionSkilled

Skill

Proficiency Level
Basic KnowledgeNeed SupervisionSkilled

Skill

Proficiency Level
Basic KnowledgeNeed SupervisionSkilled

Skill

Proficiency Level
Basic KnowledgeNeed SupervisionSkilled

Skill

Proficiency Level
Basic KnowledgeNeed SupervisionSkilled

Skill

Proficiency Level
Basic KnowledgeNeed SupervisionSkilled

Skill

Proficiency Level
Basic KnowledgeNeed SupervisionSkilled

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Languages:

Language

FluentReadWrite

Language

FluentReadWrite

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Interets:

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Volunteering:

Volunteer availability
Start date and hours/week

Reason for Volunteering
Give a brief description

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Testimony:

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References:

Give the names of 2 professional & 1 church leader not related to you, whom you have known at least one year

Name

Address

Contact Number

Relationship

Name

Address

Contact Number

Relationship

Name

Address

Contact Number

Relationship

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In Case of an Emergency, Notify:

Name

Phone

Relationship

Address

City

State

Zip Code

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Statement of Understanding:

I hereby certify that the facts set forth in the above application are true and complete to the best of my knowledge. I authorize PowerQuest WorldWide to check the references listed and verify any information provided in the application. As a volunteer of PowerQuest WorldWide, I understand that I will be volunteering at my own risk and that the organization, its employees and affiliates, cannot assume any responsibility for any liability for any accident, injury or health problem which may arise from any volunteer work I perform for PowerQuest WorldWide. I agree that all the work I do is on a volunteer basis and I am not eligible to receive any monetary payment or reward. I grant PowerQuest WorldWide permission to use my likeness in a photograph, video, or other digital media (“photo”) in any and all of its publications, including web-based publications, without payment or other consideration.

Signature/Volunteer
Use your mouse to sign in the white box below - click and hold while signing