volunteer application

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PRISON PREVENTION MINISTRIES 302 Spruce Street P.O. Box 3026 Chattanooga, TN 37404 423.622.5768 [email protected] www.prisonprevention.org

Fax: 423.622.5571


Name ___________________________________ Home Phone #_ _________________________ Cell Phone # ______________________ E-mail Address _________________________________ Address__________________________________________________________________________ Street




Date of Birth___/____/___ Sex ______ Martial Status_____ Spouse’s Name ________________ Occupation _____________ Employer _________________________ Work Phone _____________ Education ________________ Are You Bi-Lingual? __________ Language Spoken _____________ Give Any Previous Experience with Prison Ministry and/or Related Training: ___________________ _________________________________________________________________________________ Give Your Experience as a Leader, Assistant, or Participant in Ministry Activities: ________________ _________________________________________________________________________________ _________________________________________________________________________________ Name of Church You Attend _____________________________ Pastor _____________________ Give Your Reasons for Wanting To Become a PPM Volunteer: _______________________________ _________________________________________________________________________________ _________________________________________________________________________________ Check area(s) of PPM Ministries in which you are interested: Jail / Prison Teaching: Men ______ Women ______ Juvenile Detention Teaching Youth* _____ Discipleship/Life Skills Seminars ______ General Bible Study _____ Other (list) ______________ Wherever Needed (Office, Phone, Maintenance, etc.) ______ * To work with youth, please note that your signature on this form authorizes PPM to request references, employment history and run a background check. Have you been charged / convicted of any crime, any sex-related or child abuse-related offense?  No  Yes If YES, when? ________ For What Offense? ________________________________

Were You Incarcerated?  No  Yes

Are You Currently On Parole / Probation?  No  Yes

I am not aware of anything that would make me ineligible to serve with PPM. I have a sense of calling and purpose to minister to incarcerated persons. I am willing to abide by PPM’s training S and philosophy and to cooperate with all rules imposed by the Departments of Corrections governing the institutions in which PPM serves.

Signature __________________________________________

Date _______________________ Revised 08/2011