Applicant Information
First Name (required):
Middle Initial:
Last Name (required):
Birthdate (mm/dd/yyyy): (required): //
Preferred Name:
Maiden Name or AKA (required - note NONE if not applicable):
Mailing Address (required):
Zip Code:
Preferred Phone: ()-
Email (required):
(The Volunteer Coordinator will contact you via this email address)
Church/Organization and City:
How did you learn about our volunteer program?
Why are you interested in volunteering here?
Have you been convicted of a felony in the past 10 years?  Yes No
If yes, please state date & offense: //
Former Addresses

List former addresses or places of residence in the last 10 years:

Employment Information
Current/Most Recent Employer:
Date Employed (mm/dd/yyyy): //
Student Information
Current School:
Graduation Year:

Please complete individual sections below based on your interests in volunteer service

Type of Volunteer
 Court Ordered Community Service
Court, Probation Office & Phone:
Offense(s) causing Community Service:
 Meal Provider
 On-site Volunteer
Where are you interested in volunteering?  With families: Families Moving Forward (FMF) With single adults: Project Hope for the Homeless (PH)
When would you like to volunteer?  FMF: 1 p.m. - 4 p.m. FMF: 4 p.m. - 7 p.m. PH: 7 p.m. - 11 p.m. FMF and PH: 5:30 a.m. - 7 a.m.
 General Volunteer
Name(s) & age(s) of those who might join you from your family:

To the best of my knowledge, the above information is true and is submitted voluntarily. This information may be used and disclosed for internal purposes. I realize as a volunteer for the Ecumenical Shelter Network of Lake County, Inc., I am not paid for my service, and am not covered under worker's compensation. I agree to comply with all guidelines, rules, and procedures.