VOLUNTEER

Personal Details

NAME:*

First Last

EMAIL:*

ADDRESS:

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code 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

Name

This field is for validation purposes and should be left unchanged.

YALLA Orientation Video