Part I. General Information.
First Name
Last Name
Town/city & country
you live at present:
 Age
Gender
Most suitable time
(month/year)  for you to
volunteer.
Best contact e-mail
Best contact phone
number
Most suitable duration
(in weeks) you can
volunteer.
Please let us know how
you found out about us.
Please let us know why
would you like to volunteer
and what would you like to
do, to accomplish, or to
learn/experience during
your time in Madagascar
Please list your talents,
professional interests,
skills or other attributes
which may be beneficial to
the projects.
Please list any
previous volutneering
experiences
Please list any questions
regarding volunteering with
Maventy Health International or
any special needs/additional
comments you wish to have
considered.
Part II. A brief background check.
( please note that having a negative event in your life's history does not serve as an exclusion from volunteering. However,
as random background checks are performed untruthful answers may serve as grounds for denial of your applications.
Please, answer the following questions/statements:
Yes, I am.
No, I am not.
I am a law abiding citizen of my country
yes, it is true. I
have never
been convicted
of a major crime
I have never been convicted of a major crime-like felony
No. I have been
convicted of a
major crime in
the past.
I do not abuse drugs or alcohol.  I do not smoke and am
aware that fire is a major risk for the village.
 yes. it is true. I
have not abused
drugs or alcohol in
the past three
years.
No. I have abused
drugs or alcohol in
the past three
years.
I do not have abusive tendencies or intentions of
wrongdoing; and I plan to be respectful and
helpful toward the people I will serve.
 No. I have negative intentions.
Yes. It is true. I do not have
abusive tendencies or
intentions of wrongdoing.  I
plan to be respectful toward
the people I work with and/or
serve.
yes. it is true. I do not a chronic
medical condition, social or
behavioral history which oculd
have an impact my volunteering
or interactions with others.
 No. There are factors which  may
impact my volunteering or may
will require special
accommodation if I am to
volunteer with Maventy Health
International.
I do not have a chronic medical condition, past social or
behavioral history which could have an impact on my
volunteering.
if you have answered no to
any of the above questions,
please describe in detail.
Part III. ( optional)
May be submitted at a later date during the application process.
However, if you wish to have your volunteering application process expedited, you may consider providing us with the
relevant information.
Note: If accepted, you will likely be volunteering in a territory with higher exposure to communicable & infectious
diseases.  Please if you can answer the questions about your immunizations to the best of your abilities.
Immunization history:
(please complete all
known vaccinations:
yes/no & dates)
Tuberculosis &
malaria screening
questions:
(yes/ no & dates)
I hereby attest that the provided information is true. I understand that I am applying to volunteer to
improve the quality of life for vulnerable people.  I pledge that I will volunteer in a respectful manner
and show dignity toward others. I hereby attest that I will travel and volunteer at my own risk and that
I do not intend to hold Maventy Health International responsible for any costs or illnesses which may
occur during or after my travels/volunteering.
Security question; name of
your favorite childhood pet
Part IV. Resume.
Please email your resume (Curriculum vitae) to the following email address: Maventy@doctel.net
Dear MHI volunteer candidate,
Thank you for registering your interest to volunteer with Maventy Health International. Please fill in and submit
the following questionnaire so that we can begin to process your application. Thank you. (estimated time to
complete the application is 15 minutes)
Thank you for taking the time to
apply for a volunteer position with
Maventy Health International.

We will inform you of our decision or contact you
about any questions we might have within seven
(7) days.

Maventy Health International

Volunteer Application