Long Way Home / Individual Application

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Individual Application

SECTION 1: Contact Information

If you would like to volunteer with Long Way Home, please fill out the form below and submit it or download our volunteer application and email it to our volunteer coordinator at volunteer@longwayhomeinc.org

First Name
Last Name
Street Address
City
State
Zip or Postal Code
Country
Date of Birth

Email Address
Phone Number
I prefer to to be contacted via
Best time to reach you
Emergency Contact Name
Emergency Contact Number
Emergency Contact Relation
What date would you like to start (appx.)
How long would you like to volunteer?
Do you have a specific type of work you would like to do with Long Way Home?
How did you hear about us?
If 'Other', please enter here:

SECTION 2: EDUCATION

Highest Level of Education:

Please List the schools you attended from the most recent:

School
Dates Attended
Major(s)/MInor(s)
Degree(s) Received
Year Graduated

School
Dates Attended
Major(s)/MInor(s)
Degree(s) Received
Year Graduated

School
Dates Attended
Major(s)/MInor(s)
Degree(s) Received
Year Graduated

Please list any other degrees or certifications held and year received

Please list any other academic experience that you think would be relevant to your application:

SECTION 3: Work History
Provide the following information regarding your most recent job.

Employer
Job Title
Start-End Date (MM/DD/YY - MM/DD/YY)
Duties Performed
Reason for Leaving
May we contact your employer
If so, name of supervisor
Supervisor's Phone or Email

Please list any specific work experience you think might be releveant to your application:

SECTION 4: References

List 3 people you would like to use as references. At least TWO of the references should be professional (former supervisors, for example).

Name:	Email:
Name:	Email:
Name:	Email:

SECTION 5: More Information

Why are you applying to Long Way Home?

Describe your past volunteering experience;

Decribe any international experence you have (work/ study abroad / travel)

SECTION 6: Skills Assesment
Please mark the boxes of any skill areas in which you are interested in working AND have experience.

I do not have any of the following skills but am willing to learn:

CONSTRUCTION	NON-PROFIT	GENERAL
Carpentry	Grant Writing	Gardening
Masonry	Marketing	Forestry
Electrical	Fundraising	Animal Husbandry
Water Systems	Third World Development	Trail Maintenance and Design
Alternative Energy	Website Design	Arts and Crafts
		Education
		Children's Recreation
		Nutrition
		First Aid

Please describe your experience in the above marked skills and list any other skills or talents you would bring to Long Way Home.

SECTION 7: Language Assesment

Rate your Spanish speaking abilities (1=beginner):

Rate your Spanish writing abilities (1=beginner):

Rate your Spanish reading abilities (1=beginner):

Tell us about any Spanish education you've had including any practical experience with the language

SECTION 8: Physical Fitness Assesment
Please rank your level of physical fitness:
Can you work with hand tools such as shovels, hoes, hammers, machetes, etc.?
Are you comfortable walking up and down lots of hills?
Are you able to lift 30-50 pounds?

Please list any medical conditions you have that would interfere with performing physical labor. (Long Way Home will require a full medical history prior to service.)

Note: To protect your safety and that of others volunteering, Long Way Home may require that you undergo a physical prior to service. It should be noted that anytime you visit a foreign country, you should consider getting a physical. You are required to have an up-to-date tetanus booster. Hepatitis A and B vaccines are also strongly recommended. Feel free to contact us if you would prefer to discuss this in person.

SECTION 9: Criminal or Non-Criminal History
Please list any misdemeanor or felony convictions (excluding minor traffic violations), and please explain. If you have no criminal history, please write "none."

By submitting this form, I HEREBY CERTIFY that the above repsonses are true and complete and that I have not knowingly withheld any facts, circumstances or other information which would, if disclosed, affect my volunteer service. I further understand that any false or misleading statement or omission of pertinent information will result in the rejection of my application, or in dismissal if discovered subsequent to my acceptance.

I UNDERSTAND that should I be given a position with Long Way Home, the position shall be for an indefinite period of time and may be terminated, at will, at anytime, for any reason, by me or by Long Way Home without notice or without liability whatsoever.

LONG WAY HOME is an equal opportunity employer that does not discriminate on the basis of race, color, sex, religion, national origin, sexual orientation, physical handicap or disability, age, marital status, family responsibilities, political affiliation, or any other areas of discrimination prohibited by applicable law.