Ymca Of Austin Volunteer Application Form printable pdf download

YMCA OF AUSTIN Volunteer Application

Please Print Clearly

Date:___________ Position Desired: _________________ Preferred YMCA Location: ________________

Name: _______________________________________________ Telephone:______________________

Address: _____________________________________________________________________________

City:_____________________________________________ State:________ Zip Code: _____________

Emergency Contact Name:________________________________ Telephone:______________________

Current Occupation: _________________________________________ Employed Since:_____________

Place of Employment: ___________________________________________________________________

Address: _____________________________________________________________________________

City:_____________________________________________ State:________ Zip Code: _____________

Have you ever been convicted of, been adjudicated with regard to (including an adjudication of delinquent conduct), pled

guilty to, or pled no contest to a criminal charge, or have you ever received probation or deferred adjudication for a criminal

charge? (“Conviction” includes sentenced to confinement, paid fine, served time, placed on probation (including deferred

adjudication) and paid court-ordered restitution.) If so, explain below. Note that you will not automatically be disqualified if

you answer “yes.”

 Yes

 No

How many years of previous experience do you have with the subject you will be instructing/facilitating?

What do you hope to gain from volunteering?

What other organizations have you volunteered with (if any)?

What age group do you prefer to work with: ______________________

References: Please list names, occupation and telephone numbers for 2 people who know you sufficiently

well to provide a reference. References will be contacted.

Name

Occupation

Phone Number

I hereby affirm that my answers to the foregoing questions are true and correct and that I have not knowingly withheld any fact or

circumstance that would, if disclosed, affect my application unfavorably. I understand that any false information submitted in this

application may result in my discharge.

I hereby give my permission for the YMCA of Austin to obtain information, including criminal history. I understand that this

information will be used to determine my eligibility as a volunteer for the YMCA of Austin. I also understand that as long as I remain

a volunteer, I must report any arrest or citation for criminal or felony activity to a YMCA management staff member.

_________________________________________________________________________ __________________________

Applicant Signature

Date

Updated 2/2012

Ymca Of Austin Volunteer Application Form