Date of Birth
* Date of Birth
Data Entry, Photography, Truck Driving, etc...
Do you have any physical limitations?
*Must have Parental Consent form on file if the applicant is under 18*
American Indian/Alaskan Native
Native Hawaiian/Pacific Islander
Required Community Service (See below)
Community Service for School Credit
Where would you like to serve?
Lakeland Family Store
Plant City Family Store
Brandon Family Store
Havendale Family Store
If you would like to serve in one of our stores, in what capacity?
If you would like to serve at our Central Campus, in what capacity?
Nova (Adult Learning Center)
Administration: Reception/Database Work/Mailings
Kitchen: (Women’s Kitchen or Men’s Kitchen)
Permissions & Consents:
RELEASE AND HOLD HARMLESS
I (we) release and hold harmless Lighthouse Ministries, Inc., its officers, members, employees, volunteers, agents or assigns from any and all liability including - but not limited to - personal injury, death, property loss, damage or other loss suffered or sustained by me (us) while on the premises or in connection with the receipt of the aforementioned items, and further covenant and agree for myself (us) (ours) heirs, executors, administrators and assigns not to seek civil remedy in any court of law against Lighthouse Ministries, Inc. or its officers, members, employees, volunteers, agents or assigns relating to or arising from the receipt of the aforementioned items.
CONSENT TO BINDING ARBITRATION
I (we) fully understand that any and all disputes and causes of action, whether in contract or tort, relating to or arising from Lighthouse Ministries, Inc. shall be resolved by binding arbitration according to the rules of the American Arbitration Association. Arbitration shall take place in Polk County, Florida. Each party shall bear their own attorneys fees and costs. I (we) waive my (our) right to a trial by jury or by the court and further waive my (our) right to seek any civil remedy in a court of law. I (we) have read this paragraph and understand that by executing below, I (we) are waiving important legal rights.
I have read, understood and agree with Lighthouse Ministries’ Mission Statement, Vision Statement, Core Values, and Pathways. I understand that as a volunteer at lighthouse Ministries, I will not be paid for my services and I will volunteer my time, abilities, and talents. I will respect any resident’s confidential information to which I may have access. I will respect the privacy and anonymity of the residents of lighthouse Ministries and agree not to use such information without a prior release form signed by the resident.
I understand that I do not have to agree to this background check, but that refusal may exclude me from consideration as a Lighthouse Ministries volunteer. This information is of a confidential nature, and, as such, will not be shared with other personnel except for those involved in this specific volunteer position. I also understand that all information will be kept confidential. By typing my name, I consent to the terms: