FIAGKV Volunteer Application

Faith in Action of the Greater Kanawha Valley

Volunteer Application | Confidential Information

Volunteer Information

Name*

First NameLast Name

Address*

Street Address

Street Address Line 2

CityState

Zip Code

Primary Phone*

Area CodePhone Number

Secondary Phone

Area CodePhone Number

Email

example@example.com

Birthdate*

Date

Emergency Contact Information

Emergency Contact Name*

First NameLast Name

Relationship

Emergency Contact Address

Street Address

Street Address Line 2

CityState

Zip Code

Emergency Contact Primary Phone*

Area CodePhone Number

Emergency Contact Secondary Phone

Area CodePhone Number

Emergency Contact Email

example@example.com

Physical Limitations

Do you have any physical limitations?*

YesNo

If so, please describe:

Interests

Tell us which areas you are interested in volunteering - select all that apply!*

Transportation to Medical AppointmentsGrocery ShoppingTelephone Reassurance CallsFaith in Action Office VolunteerHoney Do Crew Project (e.g. lawn care, small home repairs)

Transportation Volunteers

We cover the entire Greater Kanawha Valley including all of Kanawha and Putnam Counties. How far are you willing to drive?

Miles

Do you own your own vehicle?*

YesNo

Type of Vehicle*

License Plate Number*

State Issued*

Transportation volunteers must provide a copy of their current driver’s license and vehicle insurance card. You may upload these files here or contact Faith in Action to arrange another way of providing this information.

Browse Files

You may scan images of these files together or upload multiple files through this link.

Honey Do Crew Volunteers

Volunteer Skill Assessment

In order to match you with a home repair task that best suits your skill level, please complete the following assessment based upon your ability to perform each task.

*

	Little or no experience	Some experience	Moderate experience (comfort level)	Can accomplish	Skilled
Hang a door
Replace window pane
Replace trim around doors, windows
Paint siding, trim, windows
Install weather stripping
Caulk
Repair porch flooring
Repair porch step
Minor electrical repair
Minor plumbing repair
Use basic hand tools
Operate power tools
Operate power washer
Operate lawn mower/weed whacker
Trim trees, bushes
Perform yard cleanup

Do you have any other specific special training or skills? *

Do you have any previous experience in home repairs or other volunteer projects similar to this? *

What tools do you own that you could bring to a job site or be willing to loan to another volunteer to complete a job?

Do you own a pickup truck or SUV that you could use or let someone borrow if necessary?

YesNo

Honey Do Crew Volunteer Waiver of Liability

Check to Affirm*

I recognize and acknowledge the potential for accidents at the work site and am fully aware of possible injuries to members of the volunteer team, including myself. Therefore, I desire to protect, release, acquit, indemnify, and hold harmless from any and all claims, injuries, damages, losses, expenses or attorney fees incurred by me, my heirs, administrators, executors, or assigns. For and on behalf of myself, my heirs, administrators, executors, assigns and all other persons, firms or corporations, I do hereby release and discharge from liability all other persons on the volunteer team with me, those who notified, selected, or assigned me to the said team, Faith in Action of the Greater Kanawha Valley, its employees and representatives, successors, or assigns, from any claims, demands, damages, actions, causes of actions which I, the undersigned, have or may hereafter, and on account of, or any way growing out of injuries or damages both to persons or property resulting or that may hereafter result from the voluntary venture. This waver, release and indemnity agreement is fully understood by me and I enter the same willingly for the purposes herein above stated.

Employment History

Are you presently employed?*

YesNo

If yes, where?

Provide a brief summary of your employment history.

Previous Volunteer Experience

Summarize your previous volunteer experience.*

Special Skills or Qualifications

Summarize special skills and qualifications you have acquired from employment, previous volunteer work, or through other activities, including hobbies or sports.*

Personal References

Reference 1*

Name, Relationship, Phone #

Reference 2*

Name, Relationship, Phone #

Reference 3

Name, Relationship, Phone #

Reference 4

Name, Relationship, Phone #

Agreement & Signature

Check & Sign Below to Affirm*

I understand that I must agree to submit to a background check at my own expense ($11.95) in order to be considered for service to the vulnerable populations being served by the organization. (Secure link to background screen is available after submission of this application and will also be emailed open receipt.)I understand that I am required to participate in an orientation session before becoming an active Faith inAction of the Greater Kanawha Valley, Inc. volunteer.By submitting this application, I affirm that the facts set forth in it are true and complete. I understand that if I am accepted as a volunteer, any false statements, omissions, or other misrepresentations made by me on thisvapplication may result in my immediate dismissal.

Signature*

Use finger, mouse or stylus (as you would a pen) to sign name in box Clear

Date*

Date

One last thing before you hit submit...

How did you hear about Faith in Action of the Greater Kanawha Valley?