Ymca Of Greater Houston Volunteer Application printable pdf download

YMCA of Greater Houston

Volunteer Application

Equal Opportunity Employer

This Association does not discriminate in securing volunteers on the basis of race, color, religion, national origin, sex, marital status, disability, age or veteran

status. No question on this application is intended to secure information to be used in a discriminatory manner. Your application will be reviewed carefully;

however, its receipt does not imply that you will be accepted as a volunteer.

PERSONAL DATA

Full Legal Name

Date

Please list 3 references:

Last

First

Middle

Other/Maiden Name(s) Used:

Nicknames

Name / Phone

Please list all residences for the past 7 years beginning with the most current

________________________________

. (Attach separate sheet if needed)

________________________________

Current Street Address

City

State

County/Parish

Zip

Years/Months

________________________________

Current Street Address

City

State

County/Parish

Zip

Years/Months

Current Street Address

City

State

County/Parish

Zip

Years/Months

Date of Birth

Social Security Number

I have received the following and fully

agree to comply with the conditions

Drivers License or A #

State Issued

Expiration Date

thereof and understand if in violation

Phone Numbers

Hm (

)

Wk (

)

C (

)

I could be terminated as a volunteer:

Occupation

Email Address

•

Volunteer Behavior Code

Employer

Years

Special Professional Training, skills, hobbies:

Volunteer Signature

Community affiliations (clubs, service organizations, etc)

Do you speak any languages other than English?

YMCA Official Use Only

Which volunteer opportunities are you interested in?

Provided handbook

What is your availability?

Weekends

Hours of the day:

Orientation

Have you ever been convicted of a misdemeanor or felony, received deferred adjudication, or probation,

Submitted background check

pleaded guilty or no contest to any criminal offense, or been convicted in a military court martial*?

Yes

Initial

Date: _______________

If “YES”, please explain nature, date(s), location(s), and disposition of all offenses:

______________________________

Volunteer Administrator Signature

* N o t e : A c o n v i c t i o n r e c o r d w i l l n o t n e c e s s a r i l y b e a b a r t o v o l u n t e e r . F a c t o r s s u c h a s a g e , t i m e o f o f f e n s e , s e r i o u s n e s s , n a t u r e o f t h e v i o l a t i o n ( s ) , a n d r e h a b i l i t a t i o n

w i l l b e t a k e n i n t o c o n s i d e r a t i o n .

I h e r e b y c e r t i f y t h a t a l l t h e f o r e g o i n g i n f o r m a t i o n i s c o m p l e t e , t r u e , a n d c o r r e c t a n d t h a t I h a v e n o t k n o w i n g l y w i t h h e l d a n y f a c t o r c i r c u m s t a n c e t h a t w o u l d , i f d i s c l o s e d ,

a f f e c t m y a p p l i c a t i o n u n f a v o r a b l y . I u n d e r s t a n d t h a t a n y f a l s e i n f o r m a t i o n o r o m i s s i o n i n t h i s a p p l i c a t i o n m a y r e s u l t i n m y d i s c h a r g e a s a v o l u n t e e r .

I h e r e b y a u t h o r i z e t h e r e l e a s e o f a n y i n f o r m a t i o n i n r e g a r d t o c h e c k i n g a n d v e r i f y i n g e m p l o y m e n t , a n d c r i m i n a l h i s t o r y .

I u n d e r s t a n d t h a t t h i s i n f o r m a t i o n m a y b e u s e d

t o d e t e r m i n e m y e l i g i b i l i t y f o r a v o l u n t e e r c o a c h p o s i t i o n w i t h t h i s o r g a n i z a t i o n .

I h e r e b y r e l e a s e t h e Y M C A o f G r e a t e r H o u s t o n a n d i t s a g e n t s f r o m a n y a n d a l l l i a b i l i t y

a r i s i n g t h e r e f r o m .

S i g n a t u r e

D a t e