Child Care Volunteer Application

Child Care Volunteers must be 19 years or older

Are you 19 years or older?*
yesno

Please note that individuals who have utilized any services provided by the Nursery in the past two years are ineligible to volunteer.

Have you used any services provided by the Nursery in the past two years?*
yesno

Basic Information

First Name*

Last Name*

Nickname

Email*

Date of birth*

Street Address*

Street Address 2

City*

State*

Zip Code*

Preferred Phone #*

Preferred phone type*
homecellwork

Alternate Phone #*

Alternate phone type*
homecellwork

Emergency Contact Information

Emergency contact name*

Relationship*

Emergency contact preferred phone #*

Primary phone type*
homecellwork

Emergency contact alternate phone #

Emergency alternate phone type
homecellwork

Education

Name of high school

Name of college/university

Major/Minor

Employment Information

Occupation

Name of employer

Does your employer offer a donation matching program?
yesnodon't know

Experience, Skills, Knowledge

Community group memberships or civic affiliations (Lion's Club, Junior League, etc.)

Please list any community volunteer experience:

Organization 1

How did you help?

List another organization

Please list any training or experience (formal or informal) you have had in the following areas:

Children ages newborn to six*

Crisis settings*

With diversity*

Please explain your interest in volunteering with the child care program at the Nursery*

Have you volunteered with us before?
yesno

How did you hear about the Nursery?*
friend or familyco-workerinternet searchhands-on volunteeringvolunteer matchvolunteer fair or eventstaff or board memberplace of worshipschoolflyerother

Name of person who referred you to the Nursery:

Required Volunteering

Is your volunteer time a requirement for class, church, or other community service? *
yesno

If yes, what is the volunteering requirement?

School/institution

Professor/supervisor

Required # hours

Required completion date

Is any evaluation of your work required?*
yesno

Please be aware that you will need to meet for an interview, complete a DHS background check, and attend a pre-scheduled orientation. It may take up to eight weeks to begin your volunteer opportunity.

Schedule

Child Care Volunteers make a commitment to volunteer twice a month, for a minimum of six months. This helps ensure consistency with our volunteer staffing model.

Volunteer shifts take place seven days a week, at the following times:
7:30am - 10:30am
10:00am - 1:30pm
3:00pm - 6:00pm
6:00pm - 9:00pm

If you prefer a set schedule, please enter your top three preferred shifts (day and timeslot). Shift preferences will be discussed and confirmed during the interview.

References

Please provide three professional references (this does not include family or friends) who can speak to your volunteer abilities, character, and/or experience with children. If possible, include someone in a supervisor or management position.

Reference #1 name

Reference #1 email

Reference #1 relationship

Reference #2 name

Reference #2 email

Reference #2 relationship

Reference #3 name

Reference #3 email

Reference #3 relationship

Criminal History

All child care volunteers must submit to and pass a DHS criminal history background check. Individuals who have a record of physical violence, theft, or injuring another individual will not qualify to serve as a volunteer. If you have questions regarding the background check, please contact Amanda Keith.

Child Care Volunteer Agreement

I certify that the answers given by me are complete and true to the best of my knowledge. Any false information, omissions, or misrepresentations of facts may result in rejection of my application or discharge as a volunteer. I understand that this application form is intended for use in evaluating my qualifications and is not an offer of a volunteer position. If offered a volunteer position, I understand that my position may be terminated at any time for reasons the Nursery believes may be contrary to their best interest.
true

I understand that I will be required to complete and pass a DHS criminal history background check
true

Confidentiality Agreement

It is our policy that information obtained by anyone working in a staff or volunteer position must remain confidential regarding all sensitive and personal data pertaining to donors, staff, and children and their families who utilize Greater Minneapolis Crisis Nursery services. You may learn sensitive information about the children and families we serve, and it is critical to the success of the Nursery, and its community, that information obtained while volunteering be kept in confidence.

Do not approach or share that you know a child or family if you encounter them in your daily life. This includes:

• Seeing a child/family in public (unless they initiate contact with you)

• Seeing a child/family in the media (on the news, in the paper, etc.)

• Disclosing a relative or friend's use of the Nursery

Furthermore, children may never be photographed or filmed while at the Nursery.

I certify that I understand the above statement and will uphold the confidentiality policy.*
true

Name

Today's date

Please leave this field empty.

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