General Information

    The following fields are required:

    Name:

    Email:

    Phone:

    Home Address (Street Address, City, State and ZIP):

    Date of Birth:

    Social Security Number:

    Driver's License Number and State:

    Emergency Contact (Name, Relationship and Phone Number):

    Are you a member of a church or local community organization? If so, which one?:

    About Your Community Service

    Location Preference: Outreach Community Center in Carol StreamJubilee Furniture (Carol Stream)Discoveries Resale Shop & Furniture Annex (Warrenville)

    Please list special abilities, skills, or training that would contribute to your volunteer experience with Outreach.

    Please describe any limitations or special accommodations you may have/need as it relates to performing your community Service.

    How did you hear about Outreach’s programs and community service opportunities?

    Total Hours Needed:

    Hours Completed By:

    First Offense? YesNo

    Next Court Date:

    Description of Offense:

    Employment Background

    Choose one that most closely describes your current employment status.
    EmployedUnemployedRetiredPart-Time or Homemaker

    Current Employer (Company Name)

    Length of Employment

    Position

    Describe Your Duties

    May We Contact?
    YesNo

    Contact

    Address (Street Address, City, State and ZIP)

    Phone

    Volunteer Experience

    Please describe any previous and/or current volunteer experience you have had. Be sure to highlight any experience you may have working with children or older adults. Include the name of the organization, their address, phone number, your length of volunteer service and a contact person if possible.

    Legal Disclosures and Authorizations

    I understand that Outreach Community Ministries and its community services cannot assume responsibility for any injury that I may suffer while participating in volunteer activities and I agree to not hold them liable for any injury, damage, or loss which may be sustained while participating in such volunteer activities.
    YesNo

    I authorize Outreach Community Ministries to verify the legal information I have provided and conduct a thorough background check. Certain findings may be presented to members of the program’s Steering Committee and may impact acceptance to a program.
    YesNo

    Authorized By (Please type your full name as your electronic signature. A parent's signature is required for all participants under age 18.):

    The following questions are required for all high school students.

    I authorize Outreach Community Ministries to contact my guidance counselor.: YesNo

    High School:

    Guidance Counselor Name:

    Guidance Counselor Phone:

    The following fields are optional and designed to help us better understand the demographic make-up of our volunteers.

    Gender:

    Ethnicity:

    Level of Education:

    Level of Marital Status:

    Submit Your Application

    If you are experiencing trouble with the form, please forward your application materials to info@outreachcommin.org. Thank you.