INTERNATIONAL CHILDREN'S MEDICAL FOUNDATION VOLUNTEER APPLICATION

(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: H: ____________________ W: __________________ 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?" _____ When 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?________________________ 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

work 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? ________ 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:________________________________

Tell us "where" you are interested in volunteering: U.S. – Mexico – Central America – Africa? _______________________________ Notes: ________________________________

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?_______________________________________________________________________

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

_____________________________________________________________________________

MISC:_______________________________________________________________________

  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!