Volunteer Application

NAME :

*

SOC. SEC. NO. :

*

ADDRESS :	*

	*	*	*

HOME PHONE :

WORK PHONE :

CELL PHONE :

*

DRIVER'S LICENSE :

*

E-MAIL ADDRESS :

*

CONFIRM E-MAIL ADDRESS :

*

US CITIZEN :

Yes No *

GENDER :

Male Female *

EMERGENCY CONTACT :

*

Organization :

School or District Employee :

Yes No *

Please check all schools that you wish to volunteer at. *

Please check volunteer activities that is of interest to you.

Please check volunteer levels that are of interest to you.

I AM AVAILABLE ON : *

Monday

Tuesday

Wednesday

Thursday

Friday

VOLUNTEER ETHNICITY – PLEASE CHECK ONE :

PLEASE CHECK OTHER LANGUAGES WHICH YOU KNOW :

Volunteer Experience/Talents		*
Languages/Skills or Hobbies :

Have you ever been convicted, found guilty, entered a plea of nolo contender (no contest), entered into a
deferred prosecution or pre-trial intervention agreement, or had adjudication with held in a criminal offense other than a minor traffic violation (DUI is not a minor traffic violation)?

Please Check One : *

Yes

No

False

Are there any current criminal charges now pending against you?

Please Check One : *

Yes

No

False

Have you ever been arrested and/or convicted for any sexually related crime?

Please Check One : *

Yes

No

False

Are you currently registered on any sex offender registry or been required to register as a sex offender?

Please Check One : *

Yes

No

False

Have you ever been arrested for and/or convicted for using or selling illegal drugs (including marijuana)?

Please Check One : *

Yes

No

False

Do you currently have any court orders and/or injuctions against you involving children?

Please Check One : *

Yes

No

False

Please Check One : *

Yes

No

Please Check One : *

Yes

No

Please Check One : *

Yes

No

Please Check One : *

Yes

No

Address of Past 5 years :

Dates at this Address	Address

Alias and/or married names:

List Three (3) References:

Reference	Reference Name	Email Address	Phone	Cell Phone
#1
#2
#3

Classroom helper	Family Focus	Library assistant
Morning Mile	School projects	Wash & Dry Rags

American Sign Language	Chinese, Min Nan	Hausa	Moroccan	Spanish (Speak)
Arabic	Chinese, Wu	Hebrew	Oriya	Spanish (Write)
Arabic Tunisian (Darija)	Chinese, Xiang	Hindi	Panjabi, Eastern	Sunda
Armenian	Chinese, Yue (Cantonese)	Hungarian	Panjabi, Western	Swahili
Awadhi	Creole	Icelandic	Persian	Swedish
Azerbaijani, South	Creole-Haitian	Italian	Polish	Tagalog
Bengali	Croatian	Japanese	Portuguese	Tamil
Bhojpuri	Czech	Javanese	Romanian	Telugu
Bosnian	Dutch	Kannada	Russian	Thai
Burmese	Farsi	Korean	Serbo-Croatian	Turkish
Chinese, Gan	French	Lao	Sindhi	Ukrainian
Chinese, Hakka	French Creole	Maithili	Slovak	Urdu
Chinese, Jinyu	German	Malayalam	Slovene	Vietnamese
Chinese, Mandarin	Gujarati	Marathi	Spanish (Read)	Yoruba

Answer Confirmation....	X

*Please review your answer and check that this is the correct answer that you wish to provide.*