Volunteer | YWCA Clinton

First Name

Last Name

Today's Date

Phone

Street Address

Street Address Line 2

City

Region/State/Province

Postal / Zip code

Special skills, training, or certification (Languages, Red Cross First Aid, etc.)

If you know the department and/or volunteer position you are interested in, please indicate it here:

Emergency Contact: Name, Relationship, & Phone

Have you ever been convicted of a crime? A conviction record will not necessarily be a bar to volunteering, and factors such as age and time of offense, seriousness and nature of the violation, and rehabilitation will be taken into account. (Check yes or no and if yes, please explain.)

Yes

Monday Times Available (Check all that apply.)

Early Morning (5-8am)

Morning (8am-Noon)

Afternoon (Noon-5pm)

Evening (5-9pm)

Wednesday Times Available (Check all that apply.)

Early Morning (5-8am)

Morning (8am-Noon)

Afternoon (Noon-5pm)

Evening (5-9pm)

Friday Times Available (Check all that apply.)

Early Morning (5-8am)

Morning (8am-Noon)

Afternoon (Noon-5pm)

Evening (5-9pm)

Tuesday Times Available (Check all that apply.)

Early Morning (5-8am)

Morning (8am-Noon)

Afternoon (Noon-5pm)

Evening (5-9pm)

Thursday Times Available (Check all that apply.)

Early Morning (5-8am)

Morning (8am-Noon)

Afternoon (Noon-5pm)

Evening (5-9pm)

Saturday Times Available (Check all that apply.)

Morning (7am-Noon)

Afternoon (Noon-5pm)

Sunday Times Available (Check all that apply.)

Sundays (11am-3pm)

The information you have provided in this application is true, correct, and complete. If you become a volunteer, any misstatement or omission of fact on this application may result in termination of your volunteer duties. Acceptance of a volunteer position means that you will agree to any required background checks and training. By signing below, you understand and agree.

Your Signature

Today's Date

In connection with my application for employment or to serve as a volunteer with YWCA Clinton, I understand that a "consumer report" and/or "investigative consumer report" as defined by the Fair Credit Reporting Act (15 U.S.C § 1681), will be requested by Client for employment or volunteer purposes, whichever is applicable, from Protect Youth Sports, Inc., ("Protect Youth Sports"), a consumer reporting agency as defined by the Fair Credit Reporting Act. These reports may include information as to my character, general reputation, personal characteristics or mode of living, whichever are applicable. They may involve interviews with sources such as my neighbors, friends, or associates. The report may also contain information about me relating to my criminal history, credit history, driving and/or motor vehicle records, social security number verification, verification of education or employment history, worker's compensation (only after a conditional job offer) or other background checks. Such reports may be obtained at any time after receipt of this Disclosure and Authorization and if I am hired or serve as a volunteer, whichever is applicable, throughout the course of my employment or volunteer service, as permitted by law and unless revoked by me in writing. Clint also reserves the right to share my report with any third-party with whom I will be placed to work or volunteer with as a representative of Client. I understand that I have the right, upon written request made within a reasonable amount of time after the receipt of this notice, to request disclosure of the nature and scope of any investigative consumer report to Protect Youth Sports, Inc., 14499 N. Dale Mabry Hwy., Suite 201 South, Tampa, FL 33618 or 877-319-5587. For information about Protect Youth Sports' privacy practices, see www.protectyouthsports.com.

By indicating below, I authorize Client or its authorized agents to obtain or prepare consumer reports or investigative consumer reports about me. I acknowledge receipt of a copy of the federal notice entitled A Summary of Your Rights under the Fair Credit Reporting Act and certify that I have read this Disclosure and Authorization as well as the summary document explaining my rights under the Fair Credit Reporting Act.

Your Signature

Today's Date

Last Name

First Name

Home Address (Street, City, State, Zip)

SSN

DL or State ID Number

State Issued

Phone

Date of Birth

Volunteer with YWCA Clinton

Volunteer Information Form

YWCA Clinton

Lyon's Childcare Campus

Empowerment Center Hotline