VOLUNTEER
eat-a-guava-213
2017-02-16T13:40:29+00:00
YALLA Orientation Video
YALLA Volunteer Application Form
A COPY OF VALID GOVERNMENT ISSUED PHOTO IDENTIFICATION MUST BE ATTACHED TO COMPLETE THIS APPLICATION.
Personal Details
NAME:
*
First
Last
EMAIL:
*
ADDRESS:
Street Address
Address Line 2
City
State / Province / Region
ZIP / Postal Code
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Antigua and Barbuda
Argentina
Armenia
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Colombia
Comoros
Congo, Democratic Republic of the
Congo, Republic of the
Costa Rica
Côte d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Denmark
Djibouti
Dominica
Dominican Republic
East Timor
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
Gambia
Georgia
Germany
Ghana
Greece
Greenland
Grenada
Guam
Guatemala
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Mauritania
Mauritius
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
Netherlands
New Zealand
Nicaragua
Niger
Nigeria
Northern Mariana Islands
Norway
Oman
Pakistan
Palau
Palestine, State of
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Poland
Portugal
Puerto Rico
Qatar
Romania
Russia
Rwanda
Saint Kitts and Nevis
Saint Lucia
Saint Vincent and the Grenadines
Saint Martin
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Sint Maarten
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
Spain
Sri Lanka
Sudan
Sudan, South
Suriname
Swaziland
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Togo
Tonga
Trinidad and Tobago
Tunisia
Turkey
Turkmenistan
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
Virgin Islands, British
Virgin Islands, U.S.
Yemen
Zambia
Zimbabwe
Country
CELL PHONE:
HOME PHONE:
BUSINESS PHONE:
Service Learning
If you are volunteering from an academic course, please list your professor and course title.
Do you have children in the program?
YES
NO
If YES list full names and ages:
OCCUPATION:
EMPLOYER:
EMPLOYER'S EMAIL:
Skills & Experience
SPECIAL TRAINING: (Professional; skills; hobbies)
COMMUNITY AFFILIATIONS: ( Clubs, Service Organizations, etc.)
VOLUNTARY HISTORY: (Previous volunteer experience including year/s)
SPECIAL CERTIFICATION: ( Teaching; CPR; Medical; etc.)
VALID DRIVER'S LICENSE:
YES
NO
DRIVER'S LICENSE#:
DRIVER'S LICENSE STATE:
In which of the following would you like to participate? (Check one or more)
Coaching
Tutoring
Mentoring
Fundraising
Administrative Support
PR/Marketing/Web
Reference
If possible, please list a professional reference who has knowledge of your participation as a volunteer in a youth program:
REF 1 NAME:
First
Last
REF 1 PHONE:
REF 1 EMAIL:
RELATIONSHIP TO YOU:
Background Checks
Have you ever been convicted of or plead guilty to any crime(s) involving or against a minor?
YES
NO
If YES, describe each in full:
Are there any criminal charges pending against you regarding any crime(s) involving or against a minor?
YES
NO
If YES, describe each in full:
Have you ever been refused participation in any other youth programs?
YES
NO
If YES, explain:
AS A CONDITION OF VOLUNTEERING, I give permission for the YALLA organization to conduct background check(s) on me now and as long as I continue to be active with the organization, which may include a review of sex offender registries (some of which contain name only searches which may result in a report being generated that may or may not be me), child abuse and criminal history records. I understand that, if appointed, my position is conditional upon the YALLA organization receiving no inappropriate information on my background. I hereby release and agree to hold harmless from liability the YALLA organization, the officers, employees and volunteers thereof, or any other person or organization that may provide such information. I also understand that, regardless of previous appointments, YALLA is not obligated to appoint me to a volunteer position. If appointed, I understand that, prior to the expiration of my term, I am subject to suspension by the Executive Director and removal by the Board of Directors for violation of YALLA policies or principles.
APPLICANT SIGNATURE
Date
IF MINOR/PARENT SIGNATURE
Date
ATTACH A COPY OF VALID GOVERNMENT ISSUED PHOTO IDENTIFICATION
Administrative Use Only
BG CHECK SATISFACTORY:
YES
NO
REVIEW DATE:
POSITION OFFERED:
YES
NO
POSITION TITLE:
POSITION ACCEPTED:
YES
NO
START DATE:
Submit Application
Comments
This field is for validation purposes and should be left unchanged.