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VOLUNTEER APPLICATION

 

Name: Middle: Last:
Date of Birth: Home Address: City:
State: Zip: Email:
Home Phone: Work Phone: Cell Phone:
Male Female Social Security#: Employer:
Employer Address: City: State: Zip:
Occupation: Ethnicity: Marital Status:
Can We Contact You At Work?: Work Hours:
How Long Employed: Drivers License Yes No
If Yes, state of issue and #: Expiration Date:
Have you volunteered before? When and Where:
What age child are you interested in mentoring? Do you own pets? Yes No
If Yes, Please specify type of pet, size and age

 

References

 
1. Employers's Name (or school if student) Supervisors's Name (or teacher if a student)
Address: City: State: Zip:
Day Phone #: Fax #: Email:
2. Co-worker or friend or neighbor:
Address: City: State: Zip:
Day Phone#: Fax#: Email:
3. Spouse/Demestic Partner/Friend:
Address: City: State: Zip:
Day Phone#: Fax#: Email
 
Interests, Skills and Hobbies Checklist
 
Check the box, which best describes how you feel about each of these activities
ACTIVITY
ENJOYS
DISLIKES
LIKE TO TRY
Horseback Riding
Boating
Skiing/ Snowboarding
Board Games
Watching Sports
Playing Sports
Fishing
Reading
Movies
Roller Blading
Sewing
Cooking
Painting
Video Games
Computers
Biking
Crafts
Music
Bowling
Visiting the Library
Going out to Eat
Hiking
Visiting Museums

 

I understand that:
                  

  1. the references I listed may be contacted by mail, telephone, or email; 
  1. I am in no way obligated to perform any volunteer services;
  1. the information I provided may be used to conduct a background check, to include a driving record check, a criminal background check, and other records where required by local, state, or federal law for volunteers working with youth; 
  1. in order to ensure the highest standards in the volunteer selection process a policy of confidentiality is maintained for all sources who provide information about an applicant.  A decision which results in rejection will, therefore, not be explained nor is an appeal process available;
  1. Mentoring Plus does not discriminate nor exclude children or volunteers on the basis of race, religion, national origin, gender, sexual orientation, veteran status, disability or martial status of the parent;
  1. Mentoring Plus is not obligated to match me with a youth;
  1. other volunteer agencies or youth organizations where I have worked or volunteered may be contacted as references; and,
  1. as part of the application processe, I will be asked to provide additional personal information prior to any recommendations for matching.
  1. I hereby release Mentoring Plus from any and all claims for injuries to myself, and any and all expenses of losses which may occur, while engaged in match activities.
Sign Name:

* By signing your name and clicking finish you agree to all terms and conditions above...

 

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