Apply to be a Seton Center Volunteer Title Dr. Ms. Mr. Mrs. Miss Individual or Group Name If group, point of contact name and phone number If individual, please list other names used (e.g. maiden names, etc.) Address Primary Phone Primary phone is: Home/Landline Home/Mobile Work Other Alternate/Mobile Phone Email Date of Birth (mm/dd/yyyy) I am interested in volunteering in these areas: (Check all that apply) Office administration/Reception Mentoring Financial or Life Coach Seasonal Programs (Helping Hands) Advertising (distributing fliers, posters, etc.) Getting Ahead Facilitator Program and Meal Sponsors Build Your Resources Workshop presenter Staying Ahead Social Capital Connectors Prayer Warriors Board/Committee Member Family Store Cashier Sorting/Pricing Associate Food Pick-up/Delivery Special Events Other (please specify below) If Other, please specify: Volunteer/Relevant Work Experience (include organization, duties, dates, and a point of contact) Please list any relevant education Personal Reference Name (must be over age 18) Personal Reference Address (must be over age 18) Personal Reference Phone (must be over age 18) Personal Reference Email (must be over age 18) How long have you known this reference? Relationship to Reference Family Reference Name (must be over age 18) Family Reference Address (must be over age 18) Family Reference Phone (must be over age 18) Family Reference Email (must be over age 18) Relationship to Reference Professional Reference Name (must be over age 18) Professional Reference Address (must be over age 18) Professional Reference Phone (must be over age 18) Professional Reference Email (must be over age 18) How long have you known this reference? Relationship to Reference Do you have any physical conditions that would prevent or limit your ability to perform specific tasks or duties? Yes No If yes, please explain Please indication the days and times you are available Emergency Contact (Name, Address, Phone, Email) How did you hear about Seton Center? SUBMIT MY APPLICATION
