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Bully Prevention Alliance Volunteer Application

Bully Prevention Alliance
Bully Prevention Alliance

The document is a volunteer application for the Bully Prevention Alliance. It requests basic contact information, availability, interests and skills. It also asks about prior volunteer experience, references, criminal history and permission to conduct background/driving checks. Applicants can choose to allow or deny the use of photos for publicity. By signing, applicants affirm they answered truthfully and understand intentionally false information could deny them volunteer rights.

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1 Bully Prevention Alliance Volunteer Application Please print clearly and fill out the application completely Name (first, middle, and last) ______________________________________________ Home Address _________________________________ Apt/Suite _______________ City ________________________ State _________________ Zip _______________ Phone Numbers __________________ ___________________ _________________ Cell Home Work Best time to call: ________________________ Email ____________________________________________________________ Preferred Method of Communication (please circle): Cell Home Work Email Male ( ) Female ( ) Date of Birth ________________________________ Social Security Number (needed for background check) _________________________ Current Employer ____________________________ Position ___________________ Work Address __________________________________________________________ City __________________________ State ______________ Zip ________________ Why are you interested in volunteering with the Bully Prevention Alliance (if you need additional space please use the last page)? 息 2011. U.S. Bully Prevention Alliance. Indianapolis, Indiana.
2 How did you hear about the Bully Prevention Alliance? ( ) Word of Mouth ( ) Other Please describe _______________________________________________________________ I would like to be considered for the following volunteer opportunities (select all that apply): ( ) School Activities ( ) Special Events ( ) Office Help ( ) Other Please describe ___________________________________________________________________ ___________________________________________________________________ Please list any languages that you speak, read, and/or write fluently in addition to English: ______________________________________________________________________ Have you volunteered for other organizations? _____ Yes _____ No (If you checked Yes, please continue below) Organization Name: _____________________________________________________ Dates of Service: _______________________________________________________ Describe volunteer service: Organization Name: _____________________________________________________ Dates of Service: _______________________________________________________ Describe volunteer service: 息 2011. U.S. Bully Prevention Alliance. Indianapolis, Indiana.
3 Please describe any work experience you think might be relevant to our program: Do you have any hobbies or special talents that you may be able to offer as a volunteer? What age group do you enjoy working with the most: (You can circle more than one group below) Youth (ages 6 12) Teens (ages 13 18) Adults (18 & older) Please list three references: ______________________________________________________________________ Name Relationship Time Known Phone Number ______________________________________________________________________ Name Relationship Time Known Phone Number ______________________________________________________________________ Name Relationship Time Known Phone Number Have you ever been charged with or convicted of the following: (please check yes or no) a) Felony _____ Yes _____ No b) Any crime involving a sexual offense, an assault, or the use of a weapon? _____ Yes _____ No c) Any crime involving the use, possession, or the furnishing of drugs or hypodermic syringes? _____ Yes _____ No d) Reckless driving, operating a motor vehicle while under the influence, or driving to endanger? _____ Yes _____ No 息 2011. U.S. Bully Prevention Alliance. Indianapolis, Indiana.
4 If you answered Yes to any of the previous four items, please explain: Bully Prevention Alliance has my permission to: (please check below) Run a background check on me: _____ Yes _____ No Run a motor vehicle records check on me if I decide to operate a vehicle on behalf of the Bully Prevention Alliance: _____ Yes _____ No Verify the three references I have provided: _____ Yes _____ No Release for Publication (please initial below) While you are serving as a volunteer for Bully Prevention Alliance, there will be occasions when you may be photographed and/or videotaped by staff, sponsors, corporate representatives, media, and others. We request permission for your participation. By initialing below, you may choose to grant or deny Bully Prevention Alliance permission to use photographs or videotapes of yourself, alone or in groups, in newspaper articles, newsletters, web site, brochures, special fundraising activities, scrapbook, videos and photo albums for use in public understanding and support of Bully Prevention Alliances activities and program. By granting permission below, you hereby release and hold harmless Bully Prevention Alliance from any claims, judgments or demands which may arise from the use of the above referenced photographs and/or videotapes. Please initial your selection below: _________ Yes, I give my permission for participation as described above _________ No, I deny consent for participation as described above. By signing below, I affirm that I have answered all questions truthfully. I understand that if any portion of this application is found to be intentionally false, I may be denied the right to volunteer for Bully Prevention Alliance. __________________________________________ _____________________ Your Signature Date 息 2011. U.S. Bully Prevention Alliance. Indianapolis, Indiana.
5 息 2011. U.S. Bully Prevention Alliance. Indianapolis, Indiana.

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Bully Prevention Alliance Volunteer Application

  • 1. 1 Bully Prevention Alliance Volunteer Application Please print clearly and fill out the application completely Name (first, middle, and last) ______________________________________________ Home Address _________________________________ Apt/Suite _______________ City ________________________ State _________________ Zip _______________ Phone Numbers __________________ ___________________ _________________ Cell Home Work Best time to call: ________________________ Email ____________________________________________________________ Preferred Method of Communication (please circle): Cell Home Work Email Male ( ) Female ( ) Date of Birth ________________________________ Social Security Number (needed for background check) _________________________ Current Employer ____________________________ Position ___________________ Work Address __________________________________________________________ City __________________________ State ______________ Zip ________________ Why are you interested in volunteering with the Bully Prevention Alliance (if you need additional space please use the last page)? 息 2011. U.S. Bully Prevention Alliance. Indianapolis, Indiana.
  • 2. 2 How did you hear about the Bully Prevention Alliance? ( ) Word of Mouth ( ) Other Please describe _______________________________________________________________ I would like to be considered for the following volunteer opportunities (select all that apply): ( ) School Activities ( ) Special Events ( ) Office Help ( ) Other Please describe ___________________________________________________________________ ___________________________________________________________________ Please list any languages that you speak, read, and/or write fluently in addition to English: ______________________________________________________________________ Have you volunteered for other organizations? _____ Yes _____ No (If you checked Yes, please continue below) Organization Name: _____________________________________________________ Dates of Service: _______________________________________________________ Describe volunteer service: Organization Name: _____________________________________________________ Dates of Service: _______________________________________________________ Describe volunteer service: 息 2011. U.S. Bully Prevention Alliance. Indianapolis, Indiana.
  • 3. 3 Please describe any work experience you think might be relevant to our program: Do you have any hobbies or special talents that you may be able to offer as a volunteer? What age group do you enjoy working with the most: (You can circle more than one group below) Youth (ages 6 12) Teens (ages 13 18) Adults (18 & older) Please list three references: ______________________________________________________________________ Name Relationship Time Known Phone Number ______________________________________________________________________ Name Relationship Time Known Phone Number ______________________________________________________________________ Name Relationship Time Known Phone Number Have you ever been charged with or convicted of the following: (please check yes or no) a) Felony _____ Yes _____ No b) Any crime involving a sexual offense, an assault, or the use of a weapon? _____ Yes _____ No c) Any crime involving the use, possession, or the furnishing of drugs or hypodermic syringes? _____ Yes _____ No d) Reckless driving, operating a motor vehicle while under the influence, or driving to endanger? _____ Yes _____ No 息 2011. U.S. Bully Prevention Alliance. Indianapolis, Indiana.
  • 4. 4 If you answered Yes to any of the previous four items, please explain: Bully Prevention Alliance has my permission to: (please check below) Run a background check on me: _____ Yes _____ No Run a motor vehicle records check on me if I decide to operate a vehicle on behalf of the Bully Prevention Alliance: _____ Yes _____ No Verify the three references I have provided: _____ Yes _____ No Release for Publication (please initial below) While you are serving as a volunteer for Bully Prevention Alliance, there will be occasions when you may be photographed and/or videotaped by staff, sponsors, corporate representatives, media, and others. We request permission for your participation. By initialing below, you may choose to grant or deny Bully Prevention Alliance permission to use photographs or videotapes of yourself, alone or in groups, in newspaper articles, newsletters, web site, brochures, special fundraising activities, scrapbook, videos and photo albums for use in public understanding and support of Bully Prevention Alliances activities and program. By granting permission below, you hereby release and hold harmless Bully Prevention Alliance from any claims, judgments or demands which may arise from the use of the above referenced photographs and/or videotapes. Please initial your selection below: _________ Yes, I give my permission for participation as described above _________ No, I deny consent for participation as described above. By signing below, I affirm that I have answered all questions truthfully. I understand that if any portion of this application is found to be intentionally false, I may be denied the right to volunteer for Bully Prevention Alliance. __________________________________________ _____________________ Your Signature Date 息 2011. U.S. Bully Prevention Alliance. Indianapolis, Indiana.
  • 5. 5 息 2011. U.S. Bully Prevention Alliance. Indianapolis, Indiana.