Live-in Application

First Name*

Last Name*

Address*

City*

State*

Zip Code

Home Phone*

Cell phone*

Your email*

Place of employment

Birth Date

How did you hear about Mother Teresa House?*

What, if any, volunteer work have you done?

Have you been involved in hospice care? In what way?*

Our mission is to give personal care to our terminally ill guests. Are you interested in giving hands-on care?*

Please list any gifts or capabilities you would like to contribute (i.e. playing guitar, computer programming, people skills, meal preparation, calligraphy, etc.)?

What does service mean to you and what role has it played in your life?*

What makes this a good time to be a full-time Server?*

What attracted you to Mother Teresa House?*

What are your expectations about being a full-time Server at Mother Teresa House?*

What kind of growth/challenges do you think this experience might hold for you? When face with challenges, how do you handle them? How could we help you with that?*

Is there anything you cannot or are not willing to do that is normally done by volunteers?*

Do you have any special physical or health needs?*

What is your plan, including how to meet expenses, after fulfilling your commitment as a full-time Server at Mother Teresa House?*

Is there anything else you would like to tell us about yourself (i.e. interests, family, jobs, etc.)?

How long of a commitment would you like to make as a volunteer?

When would you like to begin service?*

Complete service?*

References: Please provide two to three references and their contact information. These may include employer, pastor or teacher.

Reference 1:

First Name*

Last Name*

Email*

Relationship to you:

Reference 2:

First Name*

Last Name*

Email*

Relationship to you:

Reference 3:

First Name*

Last Name*

Email*

Relationship to you:

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