212 E. Third Street • Marshfield • Wisconsin • 54449 | Phone: 715.387.6300 • Email: info@hannahcenter.com

Volunteer Opportunities
Volunteer Application

In order to submit an online application please complete the form below.

Click here to read more information about volunteering.

GENERAL INFORMATION

Name: Phone:
Street: City/State/Zip:
Email: Birthday:
Do you hold a valid Wisconsin Driver's License?
Yes No
License #:
Special skills you possess that might enhance your role at The Hannah Center:
Volunteer availability (days & times):
In an emergency, could we call you on a "spur of the moment?"
Please share any information you wish on why you want to volunteer at The Hannah Center:

VOLUNTEER PLEDGE

I, , hereby agree that as long as I am associated with The Hannah Center or am representing the organization in any capacity, I will adhere to all policies and procedures of the Hannah Center.

I will treat all information that I obtain on individual clients/residents of The Hannah Center or any organization operating on The Hannah Center premise as completely confidential, both during and after my association with The Hannah Center.

As a volunteer for The Hannah Center, my life is an example to the young women I may be guiding. Therefore, I will lead my own life according to the values which The Hannah Center attempts to impart to its residents. Finally, I will treat all information that I obtain on individual clients/residents of The Hannah Center as completely confidential, both during and after my association with the Center.

THE FOLLOWING MUST BY COMPLETED BY ALL EMPLOYEES, VOLUNTEERS AND BOARD MEMBERS.

Sexual misconduct by personnel (including officers, employees and volunteers) of The Hannah Center while performing the work of The Hannah Center is contrary to Christian principles and is outside the scope of the duties and employment of all personnel.

* All persons who are involved with The Hannah Center or The Hannah Center events must answer all of the following questions.

1. Has a civil or criminal complaint ever been filed against you alleging physical or sexual abuse? Yes No

If yes, give a short explanation of the complaint. (Please indicate the date, nature and place of the incident leading to the complaint, where the complaint was filed and the disposition of the complaint.)


2. Have you ever suspended or terminated your employment or had your employment suspended or terminated for reasons relating to allegations of physical or sexual abuse? Yes No

If yes, give a short explanation of the allegations. (Please indicate the date, nature and place of the allegations, the disposition of the allegations and your employer at the time including your employer's name, address and telephone number.)


3. Have you ever been suspended and/or had any license or certificate suspended or revoked for reasons relating to allegations of physical or sexual abuse? Yes No

If yes, give a short explanation of the allegations. (Please indicate the date, nature and place of the allegations, the disposition of the allegations and the licensing or certificate granting agency, including the agency's name, address and telephone number.)

REFERENCES

Please list three persons who can provide character references relating to your fitness for working with young people. These should not be family members or past or present employers.
Name: Phone:
Street: City/State/Zip:
Relationship:
 
Name: Phone:
Street: City/State/Zip:
Relationship:
 
Name: Phone:
Street: City/State/Zip:
Relationship:
 
The information provided in this form is correct and to the best of my knowledge. I understand that by checking the agreement box below, and submitting this form, I authorize verification of this information through communication with any person or organization named herein. I release from liability any person or organization which provides such information.

I agree