Information with an asterisk ( * ) is required to complete the form.

First Name: *
Last Name: *
Title (ie: Mr., Mrs., Pastor, Dr.):
Address: *
Apartment/Unit #:
City: *
State: *
Zip Code: *
Email Address: *
Cell Phone #:
Home Phone #:
Are you over the age of 18? *
How did you hear about I.C.B.?
Are you a member of a church? *
If so, where and how do you serve?
Have you been convicted of a felony? *
If yes, please explain:

Education

What is your highest level completed? *
Name of school: *
Major/Degree:
Are you currently a student? *
If you need volunteer hours to complete school requirements, how many hours are needed?

Volunteer Work

Which volunteer work are you most interested in? *
Other type skills (not listed):

References

Please list two professional or personal references not related to you that we may contact.

First Reference:

Full Name: *
Relationship: *
Years you have known this person: *
Phone #: *

Second Reference:

Full Name: *
Relationship: *
Years you have known this person: *
Phone #: *

Employment

Company: *
Phone #: *
Job Title: *
Supervisor: *
How long have you been employed at current job? *
Duties: *

In Case of Emergency

Contact Person's Full Name: *
Contact's Phone #: *
Relationship: *

General Questions

Do you have any medical or physical limitations - or do you take any medication we should know about before approving you as a volunteer?
Please type the text displayed in the image. This will ensure that you are not a computer. Please use lower-case letters. *
I.C.B. • PO Box 9782 • Houston, Texas 77213
(713) 396-0245 | info@communitybuilders.me
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