Alternatives Pregnancy Center 1006 Decathlon Dr. Waterloo, IA 50701 (319) 232-5683 Fax (319) 232-9351 E-mail: clientservice@alternativescenter.org Please return by emailing to clientservice@alternativescenter.org or mail attention Cara Burke. For office use only: Date Application received: Application Reviewed by: References Checked by: Interview date: Start date: Interviewer: End date: MINISTRY VOLUNTEER APPLICATION Alternatives Pregnancy Center s mission is to explore Christ-centered alternatives with those who are facing an unplanned pregnancy. Our vision is to promote a Christ-centered view that affirms the sanctity of human life. We serve women and their families by meeting the various practical needs they encounter in a crisis pregnancy. We provide spiritual encouragement, material assistance and counseling support. Name Birthday Address City State Zip Phone (home) (work) (cell) May we call you at work? E-mail Occupation and Employer (if you work outside the home) Is there another name that you ve used in your educational or work background that we would need to know to complete a background check? ADDITIONAL INFORMATION Have you ever been arrested or convicted of any criminal act more serious than a traffic violation? Yes No If yes, please explain:
EXPERIENCE 2 Specify your last three job experiences Previous volunteer experience Previous or current ministries are you involved in List skills/hobbies you enjoy doing SPIRITUAL BACKGROUND AND PERSONAL TESTIMONY Do you consider yourself a Christian? Yes No In your opinion, what does being a Christian mean to you? How comfortable are you sharing your faith? Do you have a favorite verse that summarizes your testimony? What church do you attend? How long have you attended this church? Member? Yes No Pastor s name
Alternatives Pregnancy Center is a Christian, pro-life ministry. We believe that our faith in Jesus Christ empowers us, enables us, and motivates us to minister in truth and love to this community. Please write a brief statement about how your faith would affect your volunteer work at this ministry. Under what circumstances, if any, would you consider abortion as an alternative for a woman in a crisis pregnancy situation? 3 Are you yourself (or a close relative) currently seeking to adopt a child? yes no What are your own feelings regarding the use of birth control by sexually active teenagers or unmarried adults? APPLICANT S CERTIFICATION AND AGREEMENT I certify that the facts set forth in this volunteer application are true and complete to the best of my knowledge, and I authorize Alternatives Pregnancy Center to verify their accuracy and to obtain reference information concerning my character and capabilities. I release Alternatives Pregnancy Center and any person or entity providing such reference information from any and all liability relating to the provision of such information or relating to any decisions made based upon such information. I give permission to the center to conduct a criminal background check. If I become a volunteer at Alternatives Pregnancy Center, I agree to fully adhere to its policies and rules, including those rules relating to maintaining client confidentiality. I recognize that, as a volunteer, I will serve in a different role than the employees of Alternatives Pregnancy center, and I am not seeking, nor expecting to receive, any compensation or other benefits in return for any volunteer services which I may provide for this ministry. Signed Date
4 ALTERNATIVES PREGNANCY CENTER STATEMENT OF FAITH 1. We believe the Bible to be the complete, inspired, solely infallible (without error), and the only authoritative Word of God. 2. We believe in the unity of the Godhead there are three persons: The Father, the Son, and the Holy Spirit; equal in every divine perfection and executing distinct but harmonious offices in the great work of redemption. 3. We believe in the deity of our Lord Jesus Christ, who as the eternal Son of God, became man without ceasing to be God, having been supernaturally conceived of the Holy Spirit in His virgin birth. We believe in His sinless life, in His miracles, in His vicarious and atoning death through His shed blood, in His bodily resurrection, in His ascension to the right hand of the Father, and in His personal return in power and glory. 4. We believe in the spiritual unity of believers in our Lord Jesus Christ. 5. We believe in the sanctity of human life as set forth in the scriptures. Created by God and that at conception a life exists which is a complete person worthy of respect and protection. For you created my inmost being; you knit me together in my mother s womb. I praise you because I am fearfully and wonderfully made; your works are wonderful, I know that full well. My frame was not hidden from you when I was made in the secret place. When I was woven together in the depths of the earth, your eyes saw my unformed body. All the days ordained for me were written in your book before one of them came to be. (Psalm 139.13-16) Yet you brought me out of the womb; you made me trust in you even at my mother s breast. From birth I was cast upon you; from my mother s womb you have been my God. (Psalm 22:9-10) I have read the Statement of Faith, and my signature below indicates my understanding and acceptance. Signature Date
ALTERNATIVES PREGNANCY CENTER STATEMENT OF PRINCIPLE 5 1. Alternatives Pregnancy Center is an outreach ministry of Jesus Christ through His church. Alternatives Pregnancy Center is committed to presenting the Gospel of our Lord, both in word and deed, to families with unplanned pregnancies. In order to make this commitment viable, all volunteers, board members and employees are expected to know Christ as their personal Lord and Savior. 2. Alternatives Pregnancy Center is committed to providing its clients with accurate and complete information in every circumstance. 3. Alternatives Pregnancy Center is committed to assisting women to carry their pregnancy to term by providing emotional support and practical assistance. Resources are made available so the family may face the future with hope and are able to plan constructively for themselves and their babies. 4. Alternatives Pregnancy Center never discriminates in providing service because of race, creed, color, national origin, age or marital status of its clients. 5. Alternatives Pregnancy Center never advises, provides or refers for abortions or abortifacient. 6. Alternatives Pregnancy Center offers assistance free of charge at all times. 7. Alternatives Pregnancy Center is committed to creating awareness within the local community of the needs of families involved in crisis pregnancy and of the fact that abortion only compounds the crisis. 8. Alternatives Pregnancy Center does not engage in contraceptive counseling or in referring for contraceptive services. Married women seeking contraceptive information will be urged to seek counsel, along with their husbands, from their pastor and physician. 9. Alternatives Pregnancy Center recognizes the validity of adoption as an alternative to abortion, but is not biased toward adoption when compared to the other life-saving alternatives. Alternatives Pregnancy Center is independent of adoption agencies and relates to them in the same manner as to other helpful resources. Alternatives Pregnancy Center receives no payments of any kind from these agencies and does not enter into contractual relationships with them. Adoption agencies are not established under the auspices of Alternatives Pregnancy Center. Alternatives Pregnancy Center neither initiates nor facilitates independent adoptions. 10. Alternatives Pregnancy Center is committed to promoting abstinence education. 11. Alternatives believes the Bible teaches that marriage between a man and a woman is sacred and that outside of marriage we are to live in chastity. We believe that our genders at birth have been assigned to us by God for His good purposes and for our blessing. In expression of these beliefs and to honor the biblically based values of Alternatives Pregnancy Center, we commit ourselves to a lifestyle of sexual purity in obedience to God s Word and repudiate any relationship of sexual intimacy other than one occurring in marriage between a natural-born male and a natural-born female. I have read the Statement of Principle, and my signature below indicates my understanding and acceptance. Signature Date
6 Name Date EMERGENCY CONTACTS 1) Phone Relationship 2) Phone Relationship TIME PREFERENCE TO VOLUNTEER: The center is open Monday, Wednesday, and Thursday from 9:00 am to 5:00 pm, and Tuesday 9:00 am to 6:00 pm. We will try to be flexible with your schedule. Please indicate 2 preferences in time commitment/availability below: Monday Tuesday Wednesday Thursday 9:00 10:00 11:00 12:00 1:00 2:00 3:00 4:00 5:00 6:00 Additional Comments: AREA YOU WOULD LIKE TO SERVE Client Advocate Clothing Sorter Handyperson Housekeeping Mailings Special Projects Receptionist Other Staffing does not allow for the supervision of your children during the time you are committed to volunteer.