Please fill out all information requested. Your application goes directly to our Executive Director, and we will contact you to discuss how God can use you. Questions? Call us at 855-566-3419.

Types of volunteer work you would be most comfortable with

Construction trades & project worker
Ministering to others with prayer & counseling
Visiting the needy and sharing Jesus
Mentoring & discipleship ministry
Good Samaritan Coffee fundraising
Reaching out to children
Help develop our network of churches
Follow-up & phone ministry
Missions projects

Check all that apply.

Name

First

Middle

Last

Personal Information

Maiden / Other Names

Sex

Male
Female

Date of Birth

Email Address

Cell Phone

Home Phone

Current Mailing Address

Previous Mailing Address

Emergency Contact Name

Emergency Contact Phone

Home, work or cell

Emergency Contact Relationship

Current Employer

Work Phone

Occupation / Position

Hours of Availability

1. When working in your ministry of interest, are there any physical limitations or other conditions that would prevent you from performing certain types of activities?

Yes
No

Personal Background

If yes, please explain

2. Have you ever participated in, or been accused of, convicted of, or plead guilty or no contest to abuse or any sexual misconduct, molestation, or any other sexual or assaultive crime?

Yes
No

3. Have you ever been counseled for any of the situations described in question 2 above?

Yes
No

4. Are you aware of any traits or tendencies that you possess that could pose any threat to children, youth, or adults with disabilities?

Yes
No

Reference #1 – Name

ReferencesPlease provide four (4) character references who have personally known you at least five (5) years, are 18 years of age or older, and do not live at the same address as any of the other references.Reference #1

Reference #1 – Relationship / Years Known

Reference #1 – Address

#3 working #4

Reference #1 – Cell Phone

Reference #1 – Home Phone

Reference #1 – Email

Reference #2 – Name

Reference #2

Reference #2 – Relationship / Years Known

Reference #2 – Address

Reference #2 – Cell Phone

Reference #2 – Home Phone

Reference #2 – Email

Reference #3 – Name

Reference #3

Reference #3 – Relationship / Years Known

Reference #3 – Address

Reference #3 – Cell Phone

Reference #3 – Home Phone

Reference #3 – Email

Reference #4 – Name

Reference #4

Reference #4 – Relationship / Years Known

Reference #4 – Address

Reference #4 – Cell Phone

Reference #4 – Home Phone

Reference #4 – Email

Certification

I hereby certify that all information provided is true & complete to the best of my knowledge.

Certification & Signature

Authorization

By submitting this application, I authorize Samaritan’s Global Outreach and its representatives to investigate and verify any and all of the information contained in this volunteer application, including a criminal background check and reference checks. I also authorize all previous employers, schools, and individuals herein to verify any and all information I have provided and to give any additional information in response to reference questions intended to determine my suitability for volunteer service.

Signature

Type your full legal name as your electronic signature.

Prefer paper? Download the printable application (PDF).

Volunteer Application