Form

Address*

How did you hear about Raphael House?*
Areas of Interest
Position you're applying for*
Please also select any areas below in which you would be willing to donate your time or skills
Education/Leadership Roles:

Academic Tutoring (afterschool or Saturday mornings) Activities Facilitation (art, crafts, fitness, etc.) Child Care (field-trip chaperone, story-telling, supervised child’s play) ESL Tutoring Training (career/college prep, technology, financial literacy, parenting)
Support Roles:

Clerical (copying, filing, stuffing envelopes) Facilities/Grounds (cleaning, gardening, general maintenance, painting) Kitchen (cooking, dishes, food prep, food service)
Professional Services:

Accounting/Finance Graphic Design Information Technology/Web Development Marketing/Public Relations Writing/Editing Other
Experience & Skills
Occupation
Are you currently employed?*

Yes No
Name of Your Present or Most Recent Employer*
Job Title

Address of Your Present or Most Recent Employer

Are you a student?*

Yes No
Name of school
Major
Have you done other volunteer work?*

Yes No
If so, please describe:
What motivated you to want to volunteer at Raphael House?*
Do you have special interests or life experiences that would contribute to the work we do?
Do you know any crafts or have skills that you could teach others?
Are there any languages other than English that you speak fluently?
Emergency Contact Info
Person to contact in case of emergency*
Name
Emergency Contact Phone*
- Area Code Phone Number
Availability
Please check all that apply:*

I can commit one year. I can commit 6 months. I am available for ongoing volunteer opportunities that do not require a commitment.
When can you start?*
Approximately how many hours per week can you contribute?*
Please specify the times during which you are available for each of the days listed below:
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
Additional Comments
Background
Have you ever been convicted of, or pleaded guilty to, a crime?*

Yes No
Are you currently under arrest, or released on bond or on your own recognizance, pending trial for a criminal offense?*

Yes No
If you answered yes to either of the above, please state the circumstances:
References
Reference 1*
Name
Reference 1*
- Area Code Phone Number
Reference 1
E-mail
Reference 2*
Name
Reference 2*
- Area Code Phone Number
Reference 2
E-mail

The information in this application is correct to the best of my knowledge. I authorize any references, past employers and past volunteer programs listed in this application to give you any information (including opinions) that they may have regarding my character and fitness for volunteer work in a shelter for homeless families. In consideration of the receipt and evaluation of this application by Raphael House, I hereby release any individual, church, youth organization, charity, employer, reference, or any other person or organization, including record custodians, both collectively and individually, from any and all liability for damages of whatever kind or nature which may at any time result to me, my heirs, or family, on account of compliance or any attempts to comply with this authorization. I waive any right that I may have to inspect any information provided about me by any person or organization identified by me in this application. I further state that I HAVE CAREFULLY READ THE FOREGOING RELEASE AND KNOW THE CONTENTS THEREOF AND I SIGN THIS RELEASE AS MY OWN FREE ACT. This is a legally binding agreement which I have read and understand.
Applicant's Signature:*

Raphael House Volunteer Agreement
Raphael House exists to provide a safe and secure environment for homeless families where they can work out the difficulties that led to or have been caused by their homelessness. While on duty, Raphael House volunteers are regarded as staff and are required to behave in a professional manner. Residents are to be treated with respect and dignity. Inappropriate behavior may result in immediate dismissal from volunteer responsibilities.

As a Raphael House volunteer:*

I will report for my shifts as expected. If unable to do so, I will try to find an appropriate replacement from the list of volunteers supplied to me. I will also notify my supervisor as soon as I am aware I will be unable to attend. I will refrain from the use of alcoholic beverages for at least two hours before coming in for my shift. I will not discuss the private affairs of the residents with non-staff members, nor will I disclose their names or any other information to strangers. I will not pursue a relationship with any current or former Raphael House resident outside of Raphael House unless it is with the full knowledge of his/her caseworker or is coordinated through the Raphael House Aftercare Program.

When working with children, it is important to be aware of the disturbing and traumatic rise of child physical and sexual abuse. The following policies reflect our commitment to provide protective care of all children, youth, volunteers, and staff who participate in the Raphael House program.

Adults who have been convicted of either child sexual or physical abuse should not volunteer service in any Raphael House activity or program that involves children or youth.

Working with children who are victims of abuse can be traumatic, especially for individuals with a similar history. Individuals who have such a history should discuss their desire to work with children or youth with a qualified mental health professional prior to engaging in any volunteer service.

As a Raphael House volunteer:*

I will observe the "two adult" rule. This requires that adults are never alone with children or youth without an adult partner. I will immediately report any behaviors which seem abusive or inappropriate to my supervisor.
Please answer the following questions. Your responses will be kept confidential:
Do you agree to observe all Raphael House policies regarding working with families, children, and youth?*

Yes No
Have you ever been convicted of or pleaded guilty to a crime involving children or youth?*

Yes No

I have read the preceding volunteer agreement in its entirety, and I understand and agree to observe the guidelines and safeguards listed:
Signature:*
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APPLICATION TO VOLUNTEER AT RAPHAEL HOUSE