Heartland CARES, Inc.		  
"Facing the Future Through Hope and Healing..."
 
 
Home Making a Difference Frequently Asked Questions Volunteer Application Contact Us

Volunteer with us...

HEARTLAND CARES, INC.

3025 CLAY STREET

PADUCAH, KY 42001

(270) 444-8183 OR 1-877-444-8183

VOLUNTEER APPLICATION

 
General Information
Name:
Home Address:
City:
State:
Zip Code:
County:
   
Date of Birth:
Gender: Male  Female
   
Home Telephone Number (include area code):
Best Time to Call:
Cell Phone number (if applicable):
May we leave a message? Yes
   
Occupation: Full-time Part-time
Current Place of Employment:
Title:
May we call you at work? Yes
Work Telephone Number (include area code):
Best Time to Call:
Emergency Contact
In case of an emergency, whom should we contact?
Name:
Relationship:
Telephone:
Education/Formal Professional Training
Please check each of the following that you have achieved:
High School Diploma Yes
GED Equivalent Yes
Associate Degree Yes
Trade School Certificate Yes
Trade:
Bachelor's Degree Yes
   
Major:
   
Graduate/Professional Degree Yes
Degree and Field:
Degree and Field (additional):
   
Professional License/Certification Yes
Describe:
Skills and Experience
Please check each of the following areas in which you have training, education, and/or experience:
Accounting
Epidemiology
Photography
Advocacy
Exercise Physiology
Public Policy
Advertising
Fundraising
Public Relations
Art/Graphic Design
Grant Writing
Public Speaking
Barber/Hairstyling
Graphics
Radio/Television
Bereavement Counseling
Health Care
Reception
Bookkeeping
Health Education
Record Keeping/Filing
Carpentry/Construction
Hospice
Recreation Therapy
Catering
House Cleaning
Support Groups
Clerical Skills (general)
Journalism
Tax Preparation
Communications
Legal Counseling
Therapy Counseling
Community Assessment
Library Science
Typing
Community Planning
Marketing
Word Processing
Computer Programming
Massage Therapy
Writing/Editing
Computer Publishing
Medical Research
Other (Specify)
Crisis Intervention
Notary Public
Curriculum Development
Nursing Care
Data Entry
Paralegal
Dentistry
Peer Counseling
Dietetics/Nutrition
Pet Therapy
Education
Phlebotomy
Electrical Repair
Plumbing
Do you speak a language other than English?  Yes
If yes, which language(s)?
Do you have access to a car?  Yes
Do you have access to a truck?  Yes
Do you have automotive insurance?  Yes
Do you have a valid driver's license?  Yes
   
NOTE: Your answers to the following questions are for background information only. You will not necessarily be excluded from volunteer service for past felony charges and/or other legal issues.
Have you ever been convicted of a felony?  Yes
If Yes, please describe the charge and conviction resolution.
Areas of Interest
The following are some examples of volunteer opportunities for Heartland CARES. Please check all areas of interest.
Cooking and/or serving meals for clients
Transporting clients to and from medical appointments and/or support groups
Hospital visitation
Fundraising
Newsletter development and/or editing
Moving furniture
Grant research and/or writing
Providing support for families of HIV+ clients
Special events or activities
Running errands for clients
Mentoring services
Public speaking/presentations
Booths at community events
Educational outreach
Community outreach (please specify the communities you would like to work with)
African American Community
Gay/Lesbian/Bisexual Community
Substance Abuse Community
Schools and/or teen groups
General Community
What other volunteer services do you feel you could provide for Heartland CARES?
Time and Availability
Please check the times that you would generally be available to volunteer your time and services. (This is not a firm commitment of time; you are simply indicating what times you would generally be available to provide volunteer services.)
Time of Day
MORNING (8:00 am - 12 noon)
AFTERNOON (12 noon - 5:00 pm)
EVENING (5:00 pm - 9:00 pm)
Day of the Week
Sunday
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
How did you find out about volunteer opportunities at Heartland CARES, Inc.?
Why would you like to volunteer for Heartland CARES, Inc.?


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All Rights Reserved.