Service Application
Service Application
Please provide two to three references and their contact information. These may include employer, pastor or teacher.
- Service Application
- Employment Info
- Additional Info
- References:
Personal Info
First Name
Last Name
Address
City
State
Zip Code
Home Phone
Cell Phone
Employment Info
Place of Employment
How did you hear about Mother Teresa House?
What, if any, volunteer work have you done?
Have you ever been convicted of a crime?
If yes, please explain
Have you been involved in hospice care? In what way?
Our mission is to give personal care to our terminally ill guests. Are you interested in giving hands-on care?
Are you interested in serving as an Ambassador - bringing 10 new people on a Tour of Peace over a 3 month period (with the help of our development leader)?
Additional Info
How many hours per week/month might you be available?
Please indicate the times best for you:
Sunday
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Comments:
When can you begin?
Is there anything else you would like to tell us about yourself (i.e. interests, family, jobs, etc.)?
Reference 1:
First Name
Last Name
Phone
Relationship to you:
Reference 2:
First Name
Last Name
Phone
Relationship to you:
Reference 3:
First Name
Last Name
Phone
Relationship to you
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Please check the highlighted fields.
Please check the highlighted fields.