vol-application

First Name

Last Name

Mobile Phone

emergency contact Phone

Work Phone

Home Address

Home Address 2

Home City

Home State

Home Zip

country/continent

name of your country

Work Address

Work Address 2

Work City

Work State

Work Zip

please describe how you hear about us

best time/dates for you to volunteer

please let us know why you would like to volunteer and what you would wish to accomplish during the

please list your talents,professional interests, skills or other attributes which may be benefitial

please list any previous volunteering experiences

please list any questions you have for MHI regarding your volunteering and/or any special needs or i

I understand that having a negative past event in my life’s history does not serve as an exclu

Yes I understand and agree with possible background check
No I do not understand and/or do agree with background check.

I am a law abiding citizen of my country

yes
no

I have never been convicted of a major crime-like felony

Yes it is true I have never been convicted of a major crime
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 of the fire hazard in the villages.

yes it is true I have not abused alcohol or drugs in the past 3 years
No I have abused alcohol or drugs in the past three years

I do not have abusive tendencies or intentions of wrong doing and I plan to be respectful and helpfu

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
No I have negative intentions

I do not have a chronic medical condition, past social or behavioral history which could have impact

yes it is true I do not have a history of medical condition or past social or behavioral history which could have an impact on my volunteering or interactions with others
No there are factors which may impact my volunteering or may require special accomodation if I am to volunteer with Maventy Health International

if you have answered NO to any of hte above questions, please provide detailed explanations.

this last part of application is OPTIONAL. However, if you wish to have your volunteering applicatio

Tuberculosis and malaria. Please provide us with information about your past history regarding these

I hereby attest that the provided information is true. I understand that I am applying to volunteer

yes I attest that I understand that I am volunteering at my own risk and my own expense and do not intend to hold Maventy Health International liable for possible injuries
illnesses or problems which occur during my travels
NO I disagree with such risks

please attach your current resume/CV.

please provide name, address and contact e-mail of your referrence. please also contact your referre

Maventy Health International

Volunteer Application

Dear MHI volunteer candidate,

Thank you for registering your interest to volunteer with Maventy Health International. Please fill out and submit the following online
application. Please allow approximately 7 business days to review your application. Please note that additional information may be
requested upon review. Thank you. (estimated time to complete the application is 15 minutes)