|
|
Westmoreland
Volunteer Corps
Application
Form
Click here to download application
form as a Microsoft Word document.
Westmoreland
Congregational United Church of Christ
1 Westmoreland Circle
Bethesda, Maryland 20816
Phone: (301) 229-7766 FAX: (301) 229-0989
Please complete all items, using additional paper as needed, and return
this application to volcorps@westmorelanducc.org.
Please also send two completed personal reference forms (see attached),
a resume (optional), and a copy of all college transcripts to the above
address as soon as possible. All but the 'Internal Use Only' part of
this application may be submitted to potential employers. Call us if
you have any questions.
1.
Name:
2. E-Mail: 3. Phone:
4. Address: Until
5. Other address/phone (if different after above date):
6. Place of Birth: 7. Citizenship:
8. Social Security No. 9. Birth date:
10. Marital status:
11. Denominational affiliation and name/address of home congregation
(if United Church of Christ, please state region):
12. In what languages, other than English, do you have fluency?
13. Fully describe educational experiences, including degrees,
colleges, dates and major fields of study:
14. Give full employment record, including employers, dates and nature
of duties:
15. Describe any volunteer experiences you have had over the past four
years:
16. The Westmoreland Volunteer Corps is a response to the call of
Christ to minister to those in need, and is centered on the principles
of service to others, a willingness to live simply in an intentional
spiritual community, and a dedication to spiritual growth. Please
describe how serving in the Volunteer Corps fits into your immediate
and long-term goals.
17. What type of work or emphasis, or combination thereof, do you seek
as a volunteer? (For example: health, youth, homelessness, social
service, etc., as well as: direct contact with people, administrative
support, research, writing, public policy advocacy, community
organizing, etc).
18. Do you have any major health problems/concerns which might affect
your involvement in the Volunteer Corps or with a specific kind of
service? If so, please describe.
19. How did you hear about the Westmoreland Volunteer Corps?
20. Please indicate the names and contacts for those you have asked to
write references:
Name: _________________ E-Mail: _________________ Phone:_____________
Title: ____________________________ Organization: ______________________
Name: _________________ E-Mail: _________________ Phone:_____________
Title: ____________________________ Organization: ______________________
____________________________________
FOR INTERNAL USE ONLY. PLEASE PROVIDE THE FOLLOWING INFORMATION:
In their placements, members of the Westmoreland Volunteer Corps work
with varied populations, and their jobs often carry with them a high
degree of stress. Because of this, and for our own information, it is
helpful to be aware of counseling histories. This does not determine
your acceptance to the program, but it does help with the placement
assignment.
21. Have you had serious medical or psychiatric treatment within the
last three years? Explain briefly.
22. May we contact your physician or therapist for further information
if needed? If yes:
Name: _____________________________________ Phone: _____________
Address: _________________________________________________________
23. Have you ever been convicted of any offense other than a summary
traffic or parking violation? If so, please explain.
24. Please designate a person to be contacted in case of emergency:
Name: Relationship:
Address:
Phone:
Signed: ______________________________________
Date:
Last updated Friday,
February 15, 2008
1
Westmoreland Circle
Bethesda, MD 20816
301-229-7766
Email the church office: churchinfo@westmorelanducc.org
www.westmorelanducc.org
An
Open and Affirming Congregation
|
