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INTERNATIONAL CHILDREN'S MEDICAL FOUNDATION VOLUNTEER APPLICATION

Click Here For A Downloadable PDF Copy Of This Volunteer Application Form

Any Questions: ICMFHope@Aol.Com

(All applications must be accompanied by 2 passport sized photos)

(All references WILL be checked!)

(Please mail completed form to: ICMF - PO Box 770795 – New Orleans, LA (70117)

(To expedite, mail photos and Fax application to: (775) 414-2344 Attn: ICMF)

NAME: Last_________________________________________________

First _____________________________________________ Age:_____

Spouse:__________________________________________ Age:_____

Circle One: M S D W

Address:_______________________________________________________

City: ____________________________ State: _______ Zip:___________

Phone:

Home: _______________________________________

Work: _______________________________________

Fax:________________________________________

Email:______________________________________

Children: ____________________________________________________

Ages:________________________________________________________

Church Affiliation: (Name/Address)_____________________________________________________________

_____________________________________________________________

Number of Years/Months___________________

Pastor's Name/Address: _____________________________________________________________

Do you smoke?_______

Do you ever have an occasional "social" drink?_________________

Do you consider yourself to be "Spirit-Filled?" __________________

If so, wwhen did this experience occur?________________________

Do you feel God has placed a special "calling" on your life? If so, what?_______________________________________________________

What is your understanding of "Living By Faith?"

______________________________________________________________

What has been (if any) your experience(s) in this area?______________________________________________________________

______________________________________________________________

Give two personal references who have known you at least 5 years:

1.____________________________________________________________

Add:_________________________________________________________

Phone:______________________________________________________

2.___________________________________________________________

Add:________________________________________________________

Phone:______________________________________________________

Please place an "x" beside your personal skills:

____ Typing _____(wpm_____)

____ Word Processor (Kind:____________)

____Grant Writer

____ Research

____ Public Speaker

____ General Office

____ Child Care

____ Cook

____ Housekeeping

____ Nursing Skills

____ General Maintenance

____ Plumber

____ Carpenter

____ Electrician

____ Mechanic

____ Construction (Mason)

____ Construction (Wood)

____ Landscaping

____ Other Explain:_____________________________________________________

What time do you usually arise each morning? _________________

Are you opposed to sharing room w/medically needy child if necessary? _________________________________________________

Do you consider yourself a "heavy" or "light" sleeper?____________________________________________________________

Do you consider yourself as being Flexible/Open to "change?" ________________

If no, please explain: ______________________________________________________________

Do you learn easily? __________________________________________

Would you ever be opposed to standing beside a child as they go through surgery, if necessary?_________________________

If no, explain:________________________________________________

____________________________________________________________(Use reverse side if necessary)

Do you follow instructions easily, even when you think there might be a "better" way?___________________________

Explain, if necessary:____________________________________________________

Are you opposed to travel?____________

Do you have a Passport?______________

Country of Issue?_____________________

Number?____________________________

Expiration date?_____________________

Have you ever served on the "mission" field?____________________

If so, state where ____________________________________________

When?_____________________________________________________

What capacity?_____________________________________________

How long?_________________________________________________

Do you know sign language?_________________________________

If no, are you willing to learn? _______________________________

Are you currently taking any medication? _____________________

If so, what kind? ___________________________________________

How often?_________________________________________________ (Use Reverse Side If Needed)

Can you lift over 25#?________________________

What position (i.e. Office, Hsekeeper, Cook, etc) would be your first preference? ________________________________________________

Second preference?_________________________________________

Third preference? __________________________________________

Would you be willing to volunteer in another capacity until one of your preferences becomes available?_________________________

All ICMF volunteers have their room and board furnished. Considering your room and board is furnished, what would you calculate to be your "personal" expenditures each month, including, a requirement, your personal telephone $_____________

In what form do you receive "committed" funds, i.e. Social Security, etc. ________________________________________________

Are these funds guaranteed to you each month?________________

Are they sufficient to cover your "personal" expenses?___________

If supported by a church, which one? Name______________________________________________________

Address____________________________________________________

Contact Person _____________________________________________

Committed Amount?______________ How Long?________________

Do you drive?___________ Own your own car? ________________

Insurance Co?_____________________________________________

Has your license ever been revoked/suspended?______________

If yes, the current status?___________________________________

(Use reverse side if necessary)

List all accidents and/or moving violations in the past five years:_______________________

(Use reverse side if necessary)

FOR U.S./MEXICO/CENTRAL AMERICA VOLUNTEERS:

Do you own an RV? ______________

If so, do you plan to be living in it while serving with ICMF? _______ Electrical: 120v____ 220v_______

Does it have a generator?_______________

Briefly tell us why you want to volunteer with ICMF:_____________

____________________________________________________________

____________________________________________________________ (Use Reverse Side If Needed)

Tell us/check "where" you are interested in volunteering:

_______U.S. _______Mexico ________Central America ________Africa Other: _______________________________________

Notes: _____________________________________________________

___________________________________________________________ (Use Reverse Side If Needed)

How soon would you be able to begin volunteering? ____________________________________________________________

____________________________________________________________

If accepted with ICMF would you be willing to sign a commitment of (check one)

_____3 months ___ 6 months ____ One Year

How did you hear about ICMF?______________________________________________________________

______________________________________________________________

______________________________________________________________ (Use Reverse Side If Needed)

Any other information you would like us to know about:_________________________________________________________

______________________________________________________________

Misc. Thoughts/Comments:_____________________________________

_____________________________________________________________

_____________________________________________________________ (Use Reverse Side If Needed)

Are you shopping for a special person in your life?

Be sure to visit our Fundraising Store: Agape Treasures

All proceeds from Agape Treasures purchases will be your *secure* direct deposit contribution into ICMF's bank account.

If you are not shopping today and/or are unable to volunteer, would you consider making a monetary donation? We value your gift, whether great or small, remembering and telling our children that someone “out there” cares about them. It’s people like YOU who make it possible for us to continue this great outreach. Know that you will be rewarded for your kindness!