Volunteer Application - Masonic Homes

Name*
First Middle Last
Date of Birth*
Street Address*
Street Address Address Line 2 City State ZIP Code
Email Address*
Telephone Number – Home*
Telephone Number – Work
Cellphone Number
(if other than home)
What position are you applying for?*
- Teen
- Adult (18 and older)
AKA – Also Known As
Social Security Number*
How did you hear about us?*
Have you ever been convicted of a felony?*
- Yes
- No
(A conviction will not necessarily bar you from being able to participate)
You were convicted of a felony? Please explain:*
If accepted into the Volunteer/Community Resource Program, do you have reliable transportation to and from the Masonic Home?*
- Yes
- No
Do you have any physical condition that may limit your activities?*
- Yes
- No
Please explain:*

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Employment Status
- Employed (Full time)
- Employed (Part-time)
- Unemployed
- Retired
- Student
Current Employer:*
Job Title:*
Current Duties:*
May we contact your current employer for a reference?*
- Yes
- No
Describe any previous work experience that may be relevant to the volunteer/community resource program position(s):
Title / Position Responsibilities Months worked

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Please list any extracurricular activities, clubs, volunteer work, hobbies, etc.

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Why are you interested in contributing your time and talents at the Masonic Homes?*
Indicate if Court Referral.
For School Community Service indicate number of hours needed.
Have you volunteered before?*
- Yes
- No
Where did you volunteer?*
How many months / years did you volunteer?*
Why did you leave?*
What did you like most about volunteering?*
What did you like least about volunteering?*
What do you expect to gain from volunteering at the Masonic Homes?*
What qualities do you have that would make you a good choice for our program?*

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Signature of Applicant
Check the box to indicate that you have read the legal agreement:*
- I certify that the information given in the application is true and correct and has been given voluntarily. I understand that this information may be disclosed to any party with legal and proper interest, and I release the Masonic Homes of California from any liability whatsoever for supplying such information. I understand I have the option to opt out of the volunteer program at any time with a 30 day written notice and must surrender my badge and car tag if applicable. I acknowledge the attached information is kept on record indefinitely. I understand that I will not be paid for my services as a Volunteer/Community Resource Program participant at the Masonic Homes of California.
Signature of Applicant:*
Date*
Date Format: MM slash DD slash YYYY
Parent or Guardian Acknowledgement
If applicant is under 18 years of age, a parent or guardian must check this box to indicate that they have read the legal agreement.
- I have read and understand this application and I give my child permission to be a volunteer at the Masonic Homes. I accept full responsibility for my child’s participation in this program. Additionally, I consent to emergency medical attention in the event that I cannot be reached.
Signature of Parent or Guardian:
Date
Date Format: MM slash DD slash YYYY

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Car License Plate Number*
To ensure the security of our staff and residents, all staff members, contract providers, Volunteers, and Residents are required to display a vehicle security tag on the rear-view mirror or placed in a location, which is visible to the Security and Masonic Homes staff. The following information is required for any vehicle parked on Masonic Homes’ property.
Car Make, Year, and Model*
Color*
Vehicle Security Tag Permit Acknowledgement*
- I agree
I understand that I am required to display this security tag permit according to the Security/Safety guidelines. The security permit authorizes access to the Facility and parking privileges. Should I misplace or lose the security tag permit, I am required to contact the Facility Services Department immediately. A new Security Tag permit will be issued at a cost of $5.00 per tag. Failure to present this Security Tag permit at the gate will result in a security check, which will delay my entrance to the Facility. Flagrant violation of the security and parking restrictions may result in verbal or written disciplinary action.
Comments
This field is for validation purposes and should be left unchanged.

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Volunteer
Application

Title / Position	Responsibilities	Months worked