Volunteer Application

The information you provide in this application is confidential and will not be shared with anyone outside of this ministry.

Your name (required)

Address


Phone

Social Security #

Birth date

How did you learn about the Pee Dee Pregnancy Resource Center?

Information about your family

Are you...
SingleMarriedSeparatedDivorcedWidowed

Spouse's name

Names and ages of any children you have:

Education

High School

Number of years completed
DiplomaG.E.D.
From where?

College and/or Vocational School

Number of years completed
Degree earned
In what year?
From where?

Please list any other training or degrees:

Experience

Volunteer Experience

Organization



Phone
Position/Duties
Dates? From to
Supervisor's name

Employment History

Employer



Phone
Position/Duties
Dates? From to
Supervisor's name

Additional Information

Why do you want to volunteer with the Pee Dee Pregnancy Resource Center?

Do you consider yourself a Christian? YesNo
If so, how long have you been a Christian?

Tell us about your local church.
Church name
Denomination



Phone
Pastor's name

This organization is a Christian pro-life ministry. We believe that our faith in Jesus Christ empowers us, enables us and motivates us to provide pregnancy services in this community.
Please write a brief statement about how your faith would affect your volunteer work at this center.

What special skills, talents, gifts or personality traits would you bring to this ministry?

Have you ever counseled a woman who was considering an abortion?
YesNo
If yes, please tell us more.

Have you had any traumatic experiences relating to abortion?
YesNo
If yes, please tell us more.

Have you ever known a single, pregnant woman? YesNo
If yes, please tell us more.

Under what circumstances would you consider abortion as an alternative for a woman with an unplanned pregnancy?
Never an optionIn cases of rape or incestIn cases where the mother's life was in extreme perilIn cases of extreme psychological distressOther (specify below)

Please list any books, films or other material that you have read or viewed that relate to abortion, pregnancy or alternatives to abortion.

How would you rate yourself in the following areas?

  • Knowledge of abortion methods
    ExcellentGoodFairPoor
  • Knowledge of current laws concerning abortion
    ExcellentGoodFairPoor
  • Knowledge of what the Bible teaches about abortion
    ExcellentGoodFairPoor

Are you currently or have you ever been involved in seeking to adopt a child?
YesNo
If yes, please tell us more.

What do you consider to be your possible areas of weakness?

Are there any particular personality types with whom you have difficulty working?

References

Please list 3 persons who are not related to you and who have known you for at least two years, including your pastor.
Name



Phone
Years acquainted
Relationship

Name



Phone
Years acquainted
Relationship

Name



Phone
Years acquainted
Relationship

Applicant's Certification and Agreement

I certify that the facts set forth in this volunteer application are true and complete to the best of my knowledge and I authorize the pregnancy center to verify their accuracy and to obtain reference information concerning my character and capabilities. I release the pregnancy center and any person or entity providing such reference information from any and all liability relating to the provision of such information or relating to any decisions made based upon such information. I give permission to the center to conduct a criminal background check to the extent that my volunteer duties may involve direct interaction with minors. If I become a volunteer at the pregnancy center, I agree to fully adhere to its policies and rules, including those rules relating to maintaining client confidentiality. I recognize that, as a volunteer, I will serve in a different role than the employees of the pregnancy center and I am not seeking, nor expecting to receive, any compensation or other benefits in return for any volunteer services which I may provide for this ministry.

I further certify that I have read and that I am in full agreement with the pregnancy center's Statement of Faith and Statement of Principle.

My full name entered below is in lieu of an actual physical signature for the unique purposes of this electronic form. (required)
Your name
Your email address
Today's date