IMPACT FOR LIFE CAMPUS
Providing a path toward hope and a future
16205 Kieth Harrow Blvd ♦ Houston, Texas 77084 Ph. 281-855-0014 Fax 281-855-5790 www.impactforlifecampus.org
Application Date _________________
Volunteer Position Sought ______________________________________________________________________
Last Name______________________________ First Name___________________________
Home Address _____________________________________________City: ______________Zip Code: ________
Home Phone ____________________Work Phone __________________Cell Phone_______________________
E-Mail ______________________________________________________________________________________
Highest Level of Education __________________________
Employment Experience (List your most recent work experience first)
1) Position/Title _______________________________________________________________________________
Dates of Employment (starting, ending) _____________________________
Company/Employer ___________________________________________________________________________
Address ____________________________________________________________________________________
Supervisor __________________________________________________________________________________
2) Position/Title _______________________________________________________________________________
Dates of Employment (starting, ending) _____________________________
Company/Employer ___________________________________________________________________________
Address ____________________________________________________________________________________
Supervisor __________________________________________________________________________________
3) Position/Title _______________________________________________________________________________
Dates of Employment (starting, ending) _____________________________
Company/Employer ___________________________________________________________________________
Address ____________________________________________________________________________________
Supervisor __________________________________________________________________________________
Special training, skills, hobbies __________________________________________________________________
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List the groups, clubs, organizations you are a member of that you would consider relevant to serving as a volunteer at Impact for Life Campus.
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Please describe your prior volunteer experiences (include organization names and dates of service)
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Why do you want to volunteer / what do you want to gain from this volunteer experience? ______________
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Have you ever been convicted of a felony? (If yes, please explain the nature of the crime and the date of the conviction and disposition.) Conviction of a crime is not an automatic disqualification for volunteer work.
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Do you speak any foreign languages? If yes, please list:
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Do you have a driver's license? Yes ____ or No _____ Car insurance? Yes _____ or No _______
REFERENCES: Please list three people who know you well and can attest to your character, skills and dependability. Include your current or last employer.
Name/Organization Relationship to You Phone Length of Relationship
1) ________________________________________________________________________________________
2) ________________________________________________________________________________________
3) ________________________________________________________________________________________
Emergency Contact ______________________________________________________
Relationship ________________________________Phone_______________________
List any medical conditions of that may affect your ability to perform positions requirements.
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How did you hear of Impact for Life Campus? ____________________________________________________________
Have you or any member of your immediate family received assistance from Impact for Life Campus within the last six months?
Yes _________ No __________If yes, there is a six month grace period before you may be placed in a volunteer position at Impact for Life Campus.
Please read the following carefully before signing this application:
I understand that this is an application for and not a commitment or promise of volunteer opportunity.
I certify that I have and will provide information throughout the selection process, including on this application for a volunteer position and in interviews with Bear Creek Assistance Ministries Inc. (DBA) Impact for Life Campus that is true, correct and complete to the best of my knowledge. I certify that I have and will answer all questions to the best of my ability and that I have not and will not withhold any information that would unfavorably affect my application for a volunteer position. I understand that information contained on my application will be verified by Bear Creek Assistance Ministries. I understand that misrepresentations or omissions may be cause for my immediate rejection as an applicant for a volunteer position with Bear Creek Assistance Ministries Inc. (DBA) Impact for Life Campus or my termination as a volunteer.
Signature ________________________________________________________ Date _________________
