Volunteer Application

 
 
Personal Information
Name *
Name
Date of Birth *
Date of Birth
Address *
Address
Phone *
Phone
Gender *
Volunteer Information
I'd like to volunteer:
How frequently would you like to volunteer?
I hope to volunteer:
Name of your reference *
Name of your reference
If you are a member of Xenos Christian Fellowship, please include your home group leader.
Reference's Phone *
Reference's Phone
Personal Background Information
Have you ever been arrested and/or convicted of any offense against the law? *
Have you ever committed or been accused, charged, or alleged to have committed any act of neglecting, abusing, or molesting any children? This includes sexual misconduct or sexual advancements with minors. *
As an adult, have you ever been inappropriately attracted to teens or children? *
Applicant's Certification and Agreement
I HEREBY CERTIFY THAT THE FACTS SET FORTH IN THIS INITIAL APPLICATION ARE TRUE AND COMPLETE TO THE BEST OF MY KNOWLEDGE. I UNDERSTAND THAT DISCOVERY OF FALSIFICATION OF ANY STATEMENT OR SIGNIFICANT OMISSION OF FACT MAY PREVENT ME FROM OBTAINING A VOLUNTEER POSITION OR MAY SUBJECT ME TO IMMEDIATE DISMISSAL FROM THAT POSITION. I AUTHORIZE URBAN CONCERN & HARAMBEE CHRISTIAN SCHOOL TO VERIFY ALL DATA GIVEN IN MY APPLICATION AND MY INTERVIEW WITH THE HOME GROUP LEADER OR REFERENCE LISTED IN THIS APPLICATION.
Select one *
National Criminal File Background Check Authorization/Consent
URBAN CONCERN & HARAMBEE CHRISTIAN SCHOOL WILL CONDUCT A NATIONAL CRIMINAL FILE BACKGROUND CHECK ON ALL VOLUNTEER APPLICANTS. PLEASE READ THIS AUTHORIZATION/CONSENT FORM, COMPLETE THE INFORMATION AT THE BOTTOM IN ITS ENTIRETY AND RETURN THE FORM WITH THE COMPLETED APPLICATION. DURING THE APPLICATION PROCESS AND AT ANY TIME DURING THE TENURE OF MY VOLUNTEER SERVICE WITH URBAN CONCERN & HARAMBEE CHRISTIAN SCHOOL, I HEREBY AUTHORIZE CHOICEPOINT SERVICES INC., ON BEHALF OF URBAN CONCERN & HARAMBEE CHRISTIAN SCHOOL TO PROCURE A BACKGROUND REPORT, WHICH I UNDERSTAND MAY INCLUDE INFORMATION REGARDING MY CHARACTER, GENERAL REPUTATION, OR PERSONAL CHARACTERISTICS. THIS REPORT MAY BE COMPILED WITH INFORMATION FROM COURTS RECORD REPOSITORIES, DEPARTMENTS OF MOTOR VEHICLES, PAST OR PRESENT EMPLOYERS AND EDUCATIONAL INSTITUTIONS, GOVERNMENTAL OCCUPATIONAL LICENSING OR REGISTRATION ENTITIES, BUSINESS OR PERSONAL REFERENCES, AND ANY OTHER SOURCE REQUIRED TO VERIFY INFORMATION THAT I HAVE VOLUNTARILY SUPPLIED. I UNDERSTAND THAT I MAY REQUEST A COMPLETE AND ACCURATE DISCLOSURE OF THE NATURE AND SCOPE OF THE BACKGROUND VERIFICATION TO THE EXTENT SUCH INVESTIGATION INCLUDES INFORMATION BEARING ON MY CHARACTER, GENERAL REPUTATION, OR PERSONAL CHARACTERISTICS. An administrator will call you for your Social Security Number to conduct the background check
Select One *