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| Sunday, September 05, 2010 |
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Marion Youth Development Council Boys & Girls Club Volunteer Application Please Note: If you are downloading the Volunteer Application form from our web site, please
fill out the form completely and return it to our Operations Coordinator Allison Miracle by: • Dropping it off in person • Emailing it to boysandgirlsclub370@yahoo.com • Faxing it to the (740) 387-5518 • Mailing it to the Club at 370 E Mark St Marion, OH 43302 Attn: Carol Dimoff All Applicants Must Attend a Volunteer Orientation and consent to background checks.
Basic Information Name: _____________________ Date: __________ Address: _______________________________________ City: _____________ State: __ Zip Code ________________ Preferred form of communication (circle one): Home Phone Work Phone Cell Phone Email Home Phone: ______________ Work Phone: ______________ Cell Phone: ______________ Email: ______________ Previous addresses within the past 10 years ______________ ______________ __________ Are you a student? No Yes Date of Birth: / / What school do you attend? ___________________ What grade/year are you in? ____________ Volunteer Interests & Experience
Have you done volunteer work before? No Yes If yes, where did you volunteer and what did you do? ______________________________________________________________________________ ______________________________________________________________________________
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What types of work are you interested in doing here? (Check all that apply) _____ Teen Programs _____ Tutoring/Education _____ Leadership Development _____ Sports _____ Arts Education _____ Sports/Recreation/ Fitness _____ Other: (explain) ___________________________________________________ Please list any hobbies or interests:
____________________________________________________ Why do you want to volunteer? __________________________ Availability (include days of the week and start and end times): ____________________________________________________ How did you hear about us? ______________________________________________ Personal History Have you ever been convicted of a crime? No Yes If Yes, please explain ________________________________________________________________ Have you ever been asked to leave a volunteer position? No Yes
If Yes, please explain ________________________________________________________________ Employment and Volunteer References
Employer Company Name: _____________________Title: _____________________ Company Address: ________________________________________________ Date Started: Date Left: Supervisor’s Name: _____________________Phone #: _____________________ May we contact the employer? Yes No Volunteer Experience Agency Name: ____________________________ Phone#: __________________ Address: ___________________________________________________________ Supervisor’s Name: __________________Phone#: __________________ May we contact? Yes No How long at agency? __________________ Duties: __________________ I
certify that all the answers given by me to all of the questions on
this application and any attachments are to the best of my knowledge
true and that I have not withheld any pertinent information. I
understand that any omission, misrepresentation or false information
submitted in connection with this application may result in refusal or
of summary dismissal of volunteer employment. I hereby agree that in
the course of considering my application, you may make inquiry to
ascertain information concerning my background and I understand that,
upon written request, information as to the nature and scope of the
inquiry, if one is made, will be provided to me. Signature: __________________________________________Date:______________________ |
