Volunteer Application | Good Shepherd

Thank you for your interest in volunteering at Good Shepherd Rehabilitation Network. A volunteer is a person who willingly offers to serve Good Shepherd without the expectation of compensation or payment.

To volunteer at Good Shepherd, you must:

Complete and submit the following form
Have no criminal record. A background check will be performed after your application is received.
Have an interview with Good Shepherd’s Coordinator of Volunteers, where you will discuss your interests, the volunteer opportunities available and other issues. After submitting your application you will be contacted to schedule an interview.
Have a clear (within one year) TB test. Good Shepherd will provide this at no cost.

GOOD SHEPHERD VOLUNTEER APPLICATION

Please complete and submit the following application. If you would rather have a hard-copy application mailed to you, please contact us.

Employment History

Are you currently employed: *

Yes

Current occupation:

Current employer:

Current work phone:

In Case of Emergency, Please Notify

Name: *

Relationship: *

Phone: *

References

(List two non-family references who have known you for at least one year. A Request for Reference form will be sent to the individuals listed. These forms must be returned before your interview is scheduled.)

Name(1): *

Address(1): *

City(1): *

State(1): *

ZIP code(1): *

Phone(1): *

Years known(1): *

Name(2): *

Address(2): *

City(2): *

State(2): *

Zip(2): *

Phone(2): *

Years known(2): *

Education

High School: *

College/University:

Special training (business, trade, vocational, etc.):

Are you presently attending school?: *

Yes

School Information

Which school are you attending:

Will you receive academic credit for your volunteer work?:

Yes

Areas of Interest/Skills

Please list your hobbies or general areas of interest: *

Words per minute typed:

Special programs or software experience:

Which foreign language?:

Specify other:

Volunteer Information

Is there a specific program in which you would like to volunteer?:

Have you served as a volunteer at Good Shepherd in the past?: *

Yes

Why do you wish to volunteer at Good Shepherd?: *

Please indicate the days and times that you would be willing to volunteer.:

How much time would you be willing to volunteer at each session?:

How many times each week or month would you be willing to volunteer?:

Please indicate at which location you would like to volunteer:

Volunteer Agreement

I hereby authorize and permit Good Shepherd Rehabilitation Network to obtain any records or documents pertaining to my background, including a criminal background check, which will require me to provide my social security number and my date of birth. Good Shepherd Rehabilitation Network abides by the federal Civil Rights Act and the Pennsylvania Human Relations Act. If I am accepted as a Good Shepherd Rehabilitation Network volunteer, I will maintain the schedule to which I have agreed. I will attend such in-services as are required to maintain my qualifications as a volunteer, and I will maintain strict confidentiality concerning all information regarding clients, patients and residents. I agree to have an annual TB test to be provided by Good Shepherd Rehabilitation Network at no expense to me or to have the test done elsewhere at my own expense.

Agreement: *

I agree

Guardian Information

First name:

Last name:

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