Volunteer with Susie’s Place Susie’s Place is always grateful for volunteers to help us with a variety of tasks at either of our locations. If you’re interested in volunteering, fill out this form or contact Lynn Clinton. Volunteer Application We consider applicants for all volunteer positions without regard to race, color, religion, sex, national origin, age, marital or veteran status, sexual orientation, the presence of a non-job related medical condition or handicap, or any other legally protected status. Step 1 of 4 25% Name* First Last Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAntigua and BarbudaArgentinaArmeniaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFaroe IslandsFijiFinlandFranceFrench PolynesiaGabonGambiaGeorgiaGermanyGhanaGreeceGreenlandGrenadaGuamGuatemalaGuineaGuinea-BissauGuyanaHaitiHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiNorth KoreaSouth KoreaKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew ZealandNicaraguaNigerNigeriaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSpainSri LankaSudanSudan, SouthSurinameSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.YemenZambiaZimbabwe Country Email* Phone*Phone (alternate)Are you a student?*YesNoWhat school do you attend?What is your field of study?Which of the following best describes your employment status?Currently UnemployedWorking Full-TimeWorking Part-TimeFull-Time HomemakerRetiredWho is your current employer, and job title?Are you 15 years or older?*YesNoBirth Month and Date (Do Not Include Year)Emergency Contact Name (1) First Last Emergency Contact Phone Number (1)Emergency Contact Name (2) First Last Emergency Contact Phone Number (2) Interest and AvailabilityAt which center(s) are you looking to volunteer?* Bloomington Avon Terre Haute Check any areas you're interested in helping with* Landscaping Bulk Mailing Education/Outreach Cleaning/Organizing Computer Work Donation Pick-Up/Delivery Holiday Activities Maintenance Moving Furniture Reception/Clerical Special Events Other What did you have in mind?What is your availability?* Daytime Evenings Weekends Only What days and hours are you available?When can you start? Background InformationHow did you hear about Susie's Place?*List previous volunteer work*List any special skills, training, experience (business, professional, trade, etc.) that may be applicable to volunteering with Susie's Place.Are there any medical and/or physical conditions that would prohibit you from participating at Susie's Place as a volunteer?Why do you want to volunteer with Susie's Place at this time?*List any additional information, special interests, or experiences you feel may be helpful to us in considering your application.Have you filed an volunteer application with us before?*YesNoHave you been employed by or volunteered with us before?*YesNoHave you ever been convicted of anything more than a minor traffic offense? (Criminal history checks required prior to volunteering)*YesNo References and SubmissionReference Name (1)* First Last Relationship (1)*Parent / GuardianSiblingAunt/UncleCousinGrandparentCo-Worker / ColleagueFriendPhone (1)*Reference Name (2) First Last Relationship (2)Parent / GuardianSiblingAunt/UncleCousinGrandparentCo-Worker / ColleagueFriendPhone (2)Reference Name (3) First Last Relationship (3)Parent / GuardianSiblingAunt/UncleCousinGrandparentCo-Worker / ColleagueFriendPhone (3)I certify that I am the sole and responsible applicant and the information/answers given herein are true and complete to the best of my knowledge. I consent to and authorize Susie’s Place to complete reference checks by contacting the references provided above.* I Agree PhoneThis field is for validation purposes and should be left unchanged. This iframe contains the logic required to handle Ajax powered Gravity Forms.