Portland Adventist Community Services

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Volunteer Application

Click here for a printable .pdf application.

Last Name
First Name
Mailing Address
Telephone Number
Email Address
Gender	male female
Age
Birthdate
Number of children at home
Referred by
Health Status	excellent good fair poor
Any physical limitations?	yes no
Explain
Physician's Name
Physician's Phone
Emergency Contact
Relationship
Contact Phone
How did you become intrested in volunteering at PACS?
Are you now, or have you been, a volunteer in any other organization?	yes no
If so, where?
What days would you prefer to volunteer?
What hours?
Do you speak a foreign language?	yes no
Specify
Please list community organizations, clubs, etc. to which you belong, and any offices held:
Please list those skills in which you have training, experience or special interest:
Past or current employment references:
Name of Business 1:
Contact Person:
Phone:
Name of Business 2:
Contact Person:
Phone:

I understand PACS is a drug free/alcohol free workplace. Any reason for suspicion of drug or alcohol use will be reason for dismissal as a PACS volunteer. yes no
I understand that all agency volunteers must be screened for TB once a year. yes no
Volunteer Pledge Believing that PACS has a real need of my services: I WILL be punctual and conscientious in the fulfillment of my duties and accept supervision graciously. I WILL conduct myself with dignity, courtesy and consideration. I WILL consider as confidential all information which I may hear directly or indirectly concerning a customer, client, patient, doctor, or any of the peronnel and will not seek information in regard to any of the above. I WILL take any problems, criticisms or suggestions to the Volunteer Coordinator. I WILL respect and be careful of all PACS property. I WILL uphold the traditions and standards of this agency and will interpret them to the community at large.
I will follow this pledge:	yes no

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