VOLUNTEER APPLICATION                                 
Milwaukee Rescue Mission
EQUIP Tutoring Program

(Do not press enter until you have completed the application. All * fields are required)                                                                                                                                                 
NAME*                            (first)        (m.i.)                           (last)                
                                      
                                                   
MAIDEN/PRIOR NAME(S)                   DATE OF BIRTH           SEX
               
                         
ADDRESS*                      (street)                           
(city)                                                                                           (state)          (zip)
        
       
HOME PHONE*                               MOBILE PHONE           E-MAIL*                                     

EMERGENCY CONTACT NAME                               PHONE
                
 
CURRENT EMPLOYER OR SCHOOL                                       WORK PHONE
          
 
WORK ADDRESS                  (street)

(city)                                                                                          (state)           (zip)
        
                                               
POSITION HELD                                                                      HOW LONG? 
   
 
YOUR CHURCH                                                                        MINISTER
    
 
CHURCH  ADDRESS                                 (street)              

(city)                                                               (state)       (zip)
     

CHURCH PHONE                                   


Number of school years completed       Degree (if attained)
                                               

Area(s) of study 
 

If you are currently a student, what school do you attend?
 

Equip Tutoring Program  Children’s Tutors:
 
            Please check which of the following sessions you are available to tutor: 
            Tues. 5:00-7:00           Tues. 5:00-6:00           Tues. 6:00-7:00         
             Thurs. 5:00-7:00         Thurs. 5:00-6:00         Thurs. 6:00-7:00   
     
By completing this application you are committing to:           
one semester   one school year

How did you learn of this opportunity to volunteer at MRM?
  
Please list any previous volunteer experience:
 


Please list clubs or organizations of which you are a member.
 

Please list any special interests or skills.                                                                                              

Do you speak a foreign language fluently?   If yes, please specify.  

Have you had any experience working with children? 

If so, please explain.  

What would you like to gain from being a volunteer? 


What can you offer to a child participating in this program? 
 

Describe your health. (List any allergies or physical limitations) 


Will you be fulfilling court-ordered community service through this volunteer opportunity?
  Yes  
  No  
Have you ever been convicted of a felony?
  Yes   
  No  
Have you ever been accused of child neglect or abuse?
  Yes   
  No   
Do you use illegal drugs?
  Yes   
  No   
Is there any circumstance or situation that we should be aware of regarding your ability to be trusted with children or young people?
  Yes   
  No   

If you have answered YES to any of the previous five questions, please provide an explanation.

The Milwaukee Rescue Mission reserves the right to run a background check on each and every volunteer applicant. 
 
REFERENCES: Please supply the names of two persons who may be contacted for references. One should be your pastor/minister or your present work supervisor if possible. Neither should be your relative or intimate friend.


REFERENCE NAME                                                                           RELATIONSHIP 
             
ADDRESS                                                (street)              

(city)                                                                              (state)      (zip)                  
                                
HOME PHONE                                           EMAIL
      
      
    
REFERENCE NAME                                                                           RELATIONSHIP 
             
ADDRESS                                                (street)              

(city)                                                                              (state)      (zip)                         
   
HOME PHONE                                           EMAIL
             
 

By checking this box, I grant the Milwaukee Rescue Mission permission to contact my references, above, and perform any other reasonable background check related to my interest in volunteering at the mission. 
 
SIGNATURE BOX           (type in name)
         
 
 
 



 
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