Volunteer – Friends of Crossroads Care Clinic

Name*

First Last

Address*

Street Address Address Line 2 City State ZIP Code

Email*

Let us know your preferred email address

Phone*

Let us know the best phone# to contact you

Phone Type*

Home
Cell
Business

Date of Birth*

Spouse Name (if applicable)

First Last

Children's Names & Ages (if applicable

First Name	Last Name	Age

Employment Background

Please fill out if you are currently employed or have been employed in the past 3 years.

Current Employer

Occupation

How Long?

Full or Part Time?

Previous Work History (Past 3 Years)

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Employer

Educational Background

Check all completed levels of education*

High School
Some College
Degree
Masters
Certifications
Other

List any special training, area of concentration, biblical studies, or education experiences.*

Training/Gifts

What are your strengths?*

What are your possible areas of weakness?*

What personality types do you have difficulty working with?*

Christian Walk

Do you consider yourself to be a Christian?*

Please explain what it means to be a Christian.*

How long have you been a Christian?

Briefly give your personal testimony.*

How has your life changed since your personal relationship with Jesus Christ began?*

Which church do you attend?*

Pastor's Name*

First Last

How long have you been involved at your church?

Describe positions/services performed within the church.

General Information

How did you hear about Crossroads Care Clinic (Pregnancy Resource Center)?*

What is your reason for getting involved with Crossroads Care Clinic (Pregnancy Resource Center)?*

Have you ever counseled a women who was considering an abortion?*

If you have counseled a woman considering an abortion, please explain.

Under what circumstances, if any, would you consider abortion as an alternative for a woman with a crisis pregnancy?*

Please explain Other circumstances for abortion as an option.

Have you had any traumatic experiences related to abortion?*

Please explain any traumatic experience with abortion.

How do you feel about a single woman parenting her baby?*

Are you seeking to adopt a child?*

When do you feel sexual intercourse is morally permissible?*

What are your feelings regarding birth control for teenagers or single adults who are sexually active?*

References

Please list the names and addresses of a Christian leader who knows you well and two other people who have known you at least one year.

Spiritual Reference*

First Last

Spiritual Reference Phone Number*

Spiritual Reference Email*

Professional Reference*

First Last

Professional Reference Phone Number*

Professional Reference Email*

Personal Reference*

First Last

Personal Reference Phone Number*

Personal Reference Email*

PRC Vision, Misson & Values

Providing compassion, hope and life-affirming support & equipping Iredell County with truth, purpose and integrity. Our VISION is to be the first resource women choose when facing an unplanned pregnancy, enabling them to choose God’s abundant life for themselves and their families. Our MISSON is empowering women and men to make healthy life-affirming choices regarding pregnancy, relationships and sexual health. Our VALUES are Christ-centered, compassionate, non-judgmental, confidential, relational, relevant and truthful.

Statement of Faith

1. We believe the Bible to be the inspired, infallible, authoritative Word of God. 2. We believe that there is one God, eternally existent in three persons; Father, Son and Holy Spirit. 3. We believe in the deity of our Lord Jesus Christ, in His virgin birth, in His sinless life, in His miracles, in His vicarious and atoning death through His shed blood, in His bodily resurrection, in His ascension to the right hand of the Father, and in His personal return in power and glory. 4. We believe that for the salvation of lost and sinful man, regeneration by the Holy Spirit is absolutely essential, and that this salvation is received through faith in Jesus Christ as Savior and Lord and not as a result of good works. 5. We believe in the present ministry of the Holy Spirit by whose indwelling the Christian is enabled to live a godly life and to perform good works. 6. We believe in the resurrection of both the saved and the lost; they that are saved unto the resurrection of life and they that are lost unto the resurrection of damnation. 7. We believe in the spiritual unity of believers in our Lord Jesus Christ

Our Commitment of Care & Competence

1. Clients are served without regard to age, race, income, nationality, religious affiliation, disability or other arbitrary circumstances. 2. Clients are treated with kindness, compassion and in a caring manner. 3. Clients always receive honest and open answers. 4. Client pregnancy tests are distributed and administered in accordance with all applicable laws. 5. Client information is held in strict and absolute confidence. Releases and permissions are obtained appropriately. Client information is only disclosed as required by law and when necessary to protect the client or others against imminent harm. 6. Clients receive accurate information about pregnancy, fetal development, lifestyle issues, and related concerns. 7. We do not offer, recommend or refer for abortions or abortifacients, but are committed to offering accurate information about abortion procedures and risks. 8. All of our advertising and communication are truthful and honest and accurately describe the services we offer. 9. We provide a safe environment by screening all volunteers and staff interacting with clients. 10. We are governed by a board of directors and operate in accordance with our articles of incorporation, by-laws, and stated purpose and mission. 11. We comply with applicable legal and regulatory requirements regarding employment, fundraising, financial management, taxation, and public disclosure, including the filing of all applicable government reports in a timely manner. 12. All of our staff, board members, and volunteers receive appropriate training to uphold these standards.

Signature*

I certify that the facts set forth in the applicatin are true and complete to the best of my knowledge, and I authorize the Pregnancy Center to verify their accuracy and to obtain reference information on my work performance and character. I further certify that I have read and that I am in full agreement with the Pregnancy Center's Vision, Misson & Values, Statement of Faith and Our Commitment of Care & Competence.

We would love to know where you feel most led to help us.*

Please check all that apply.

Please elaborate on Other options for helping at the PRC.