VOLUNTEER APPLICATION                                  
Milwaukee Rescue Mission
Safe Harbor

(Do not press enter until you have completed the application. All * fields are required.) 

Safe Harbor, the men’s ministries of the Milwaukee Rescue Mission, is divided into three distinct programs, each one designed to meet the needs of men who are struggling with homelessness and drug addiction. Our programming is Bible based, and we approach all our guests with the realization that only Christ can truly make lasting changes in their lives. To volunteer, please fill out the form below. 
                 
                                                                                                                         
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                                                         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? 
 
What is your availability to serve as a volunteer? Please list days, times, & months available.


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 or a participant. 
 
Please list any areas in which you have special interests or skills. 
 
Do you speak a foreign language?   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? 
 
 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 five previous 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
      

 
SIGNATURE BOX           (type in name)
         
 
  
 

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. 
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