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1.
Full Name
Street Address
City
State
Zip
Telephone
Email
Date of Birth
(ex: mm/dd/yyyy)
2.
Do You Have a Valid Drivers License
Do You Have Valid Auto Insurance
3.
In the Event of an Emergency, Please Notify
Name:
Relationship:
Phone:
Address:
4.
Education
High School:
Years Attended:
College(s):
Years Attended:
Major:
5.
List Your Work and Volunteer Experiences
Employer or OrganizationDatesPosition/Responsibilities
Were Any of the Above Experiences with Children (explain)
6.
List Your Skills
List Your Hobbies/Interests
How do you envision yourself being best used as a volunteer?
7.
Areas Of Strengths:
Areas Of Weakness:
8.
Do you have a church affiliation? If so, what church?
9.
When are you available?
10.
Have you at any time ever:
Been convicted of, or pleaded no contest to, any felony?
Yes
No
Engaged in any child molestation, exploitation, or abuse?
Yes
No
If the answer to either of these questions is, "yes," please explain in detail:
11.
Give the reference check forms to two people who know you well and can provide a character reference for you. These could include a work supervisor, teacher/professor, church leader, relative (outside immediate family), or friend. The forms should be sent back to the Volunteer Coordinator by the references.

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