Volunteer Service Application
Only for individuals serving at Northern Virginia Bahá’í Center /institutes long-term (2 or more months)

Name:      

Title: (Miss, Mr., Mrs., or Ms.)      
 First:      
Middle:     
Family/Surname:     
Nickname(s):      	
Gender: Male 	Female 			Date of Birth:      
Street Address:      
City:      
State/Province:      
Country:      
Zip Code:      
Country of Citizenship:      

Do you currently have a visa for entry into the US?      
	If you do have a visa, please attach a copy.

Are you a registered Bahá’í?	Yes 	no 
	If yes, date of registration:      
	ID number:      
	Community where registered:      

Have you applied for or served at the U.S. national schools/institutes previously?
If yes, under what name (first, middle, last)?      
If yes, what year did you previously apply/serve?      

Provide as many ways of contacting you as possible:

Home telephone:      
Work telephone:      
Cell phone:      
Fax:      
Email:      
Other email:      

Finances:
Volunteers are responsible for financing their own personal expenses with the exception of lodging and meals. Personal expenses include transportation to and from the service location, medical insurance coverage during the service term, and personal spending money (leisure activities, personal toiletries, any meals outside the NOVA Bahá’í Center/institute, etc.).

Will you have adequate funds to cover these costs?	Yes  	No 

Some partial funding is available to assist United States applicants aged 18-25 only. 
(We are unable to pay for personal expenses of individuals from outside the U.S. due to visa restrictions.)

Would you like to apply for assistance with your personal expenses?	Yes 		No 

Do you have a valid Driver’s License?
	
If yes, what type? 
(auto, chauffer, tractor, truck)

Issued from what country?      
Expiration date:      

What type of car do you drive? (automatic, manual, both)

Health:
Service at the Bahá’í Center and institutes can be physically and mentally challenging. All volunteers serving 3 or more months must submit the attached physical examination form completed by a licensed physician upon their arrival for service. 

General Health (check one):			
Excellent      	Good      	Fair      	Poor      	

Our campuses are smoke free. Do you smoke? 	Yes 		 No 

If yes, would you be willing to quit during the length of your service term? 
Yes  	No

Please describe any health restrictions or chronic ailments, which would affect your ability to serve or restrict the areas of service, which you might perform? For example: dietary restrictions, sensitivity to climate, allergies, limits for physical exertion, back problems, bleeding disorders, migraine headaches, depression, attention deficit disorders, bipolar disorder, etc.

     

NOTE: ALL VOLUNTEERS MUST HAVE MEDICAL INSURANCE COVERAGE DURING THEIR SERVICE TERM. 

If you currently have coverage, please provide the following information:

Name of Insurance Company:      
Policy Number:      
A photocopy of your medical insurance card (front and back) will be required prior to arriving for your service term.

If you currently are without coverage, temporary coverage may be purchased and proof provided upon your arrival. Do not purchase coverage until you have been invited by the Center administrators to serve and the dates of your service term confirmed. For international applicants, do not purchase coverage until you have been invited and obtained a visa.

Emergency Contact Information: (list at least two contacts)

Name:      

Relationship:      

Street Address:      
City:      
Zip code:      
Country:      

Phone:      

Name:      

Relationship:      

Street Address:      
City:      
Zip code:      
Country:      

Phone:      

List the languages you read, write and/or speak indicating level of proficiency:
	
Language:
Oral: limited  adequate  fluent   
Written: limited  adequate  fluent   
Language:
Oral: limited  adequate  fluent   
Written: limited  adequate  fluent   

Language:
Oral: limited  adequate  fluent   
Written: limited  adequate  fluent   

Language:
Oral: limited  adequate  fluent   
Written: limited  adequate  fluent   

List education and degree(s) received. Include trade and correspondence courses and apprenticeship programs:

Type of educational institution:      
From (year):      
To (year):      
Degree/diploma/certificate:      
Specialization:      
Name/Location of Institution:      

Type of educational institution:      
From (year):      
To (year):      
Degree/diploma/certificate:      
Specialization:      
Name/Location of Institution:      

Type of educational institution:      
From (year):       
To (year):      
Degree/diploma/certificate:      
Specialization:      
Name/Location of Institution:      

Work Experience:
Please attach your curriculum vitae/résumé. If it is not available, please fill in the spaces provided below. List all employment for the past 5 years, including volunteer work, apprenticeships, temporary or summer jobs, etc.
Attach additional pages if necessary.
Job Title:      
From:      		To:      
Nature of work:      

Name of employer:      
Street Address:      
City, State:      
Zip code:      
Country:      
Phone:      
Email:      

Job Title:      
From:      		To:      
Nature of Work:      

Name of employer:      
Street Address:      
City, State:      
Zip code:      
Country:      
Phone:      
Email:      

Hobbies:
Describe your hobbies:      

Bahá’í Experience:
Describe your experience as a Bahá’í including the communities in which you have lived, committees and Assemblies of which you have been a member, institute programs and/or classes you have attended or taught, conferences attended, pioneering, teaching activities, children’s classes taught, home visits completed, etc. Please include dates if known:

     

Describe your travel experience and any previous experience with new living environments:

     
Service Interests:

Although we cannot guarantee placement in your preferred location, we will try to honor your preference if possible. Identify your service location interests by numbering the locations 1-4 in order of preference (1 being first choice, 4 being last choice) in the box in front of each school name:

     	NOVA Bahá’í Center in Sterling, Virginia (visit www.novabc.org)	

There are a number of service positions available at our Bahá’í Center and institutes which require specialized skills, many positions can be filled by candidates who have transferable skills acquired as a result of their Bahá’í activities, service groups, sport or recreational pursuits, hobbies, or general duties and chores at home, on a farm or in a family business. Below is a list of some of the types of service available. What types of service are you willing to consider? Place an X in the box in front as many areas as interest you:

	Bookstore Sales and Café		Housekeeping	
	Children’s Class Teacher		Kitchen Service	
	Customer Service		Laundry Services	
	Gardening		Office Assistant	
	Grounds and Building Maintenance		Youth Education	

Do you know how to use a computer? Yes 	No 

List software programs you can use and your level of experience (e.g. Microsoft Word, Access, Excel, etc.)
     

Availability:
	What date will you be available to serve?      

	What length of time are you available to serve?      

If there are no vacancies in the month you are available, would you be available later?      

REFERENCES: Volunteers are required to provide three references, two of the three, should be Bahá’ís serving in administrative capacities such as: Local Spiritual Assembly members, Auxiliary Board members, Regional Bahá’í Council members, Continental Counselors, National Spiritual Assembly members, Cluster Institute coordinators, Regional Training Institute coordinators. Former/present tutors and co-tutors also may be identified as references for service applications. See Reference form attachment. Send the form to your references and advise them to follow the directions for emailing them to our office directly.