Volunteer Application

General Information

Name:

First Required	Last Required

Email: Required

Street 1: Required

City/State/ZIP:

City Required	State Required	ZIP Required

Phone Number: Required

Yes, I would like to receive e-mail from Buffalo City Mission

Remember me. What's this?

Question - Required - I have read the Volunteer Orientation and I accept the terms & conditions listed.

Are you under 18 years of age?

(Select one of the available choices or enter a different value.)
Question - Required -

Question - Required - Emergency Contact Name & Phone Number

Reference

Question - Required - Please list one non-relative who lives locally and knows you well. Include name and phone number

(Maximum response 255 chars, approx. 5 rows of text)

Security Information
Your response to any of these security questions will not automatically disqualify you from volunteering. However, if you answer "no" and a criminal history is found or if you answer "yes" but did not include all convictions you will be disqualified from consideration.

Question - Not Required - Have you ever been convicted (pleaded guilty or been found guilty) of a misdemeanor or felony?

Question - Not Required - List any and all convictions and provide dates of each. (Including, but not limited to, major traffic violations, writing bad checks and DWI)

(Maximum response 255 chars, approx. 5 rows of text)

Question - Not Required - Are you currently under a doctor's care or taking any medication that may impair or adversely affect the performance of your duties as a volunteer?

Question - Not Required - If so, please explain:

(Maximum response 255 chars, approx. 5 rows of text)

Question - Not Required - Have you ever been asked to relinquish a volunteer position?

Educational Experience and/or Special Training

Question - Not Required - Please check all that apply:

	GED
	High School
	Technical Training
	College

Volunteer Interests

Question - Not Required - Please identify the areas of service in which you have an interest and/or expertise (check all that apply). * Agreement with Statement of Faith is required.

	Adult Education/Computer Classes
	After-school Homework Club
	BCM Church Ambassadors
	*Chapel
	Cosmetology
	Events/Activities
	Inside/Outside Facility Upkeep
	Medical Clinic (Nurses)
	Mission Motors/Thrift Store
	Office/Clerical
	On-call Drivers
	Pantry Organizer
	Prepare/Serve Meals
	Preschool/Daycare
	Storage Room Organizer

Question - Not Required - Please indicate any additional skills, talents or training you have that may be of use in your volunteer service. If you would like to serve as a tutor, please note the subjects you are willing to teach. If you are a medical professional, please note your license number and expiration date.

(Maximum response 255 chars, approx. 5 rows of text)

Time Availability

Question - Not Required - Morning Sunday
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday

Question - Not Required - Afternoon Sunday
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday

Question - Not Required - Evening Sunday
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday

Question - Required - I have read all of the information below in full and am in agreement.

Buffalo City Mission exists to meet the spiritual and practical needs of the poor through the demonstration of the love & preaching of the Gospel of Jesus Christ.

Buffalo City Mission 100 E. Tupper Street (716) 854-8181 Contact Us Privacy Policy