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STRIVE Volunteer Application

STRIVE Volunteer Application

Volunteer with Us Today

First Name *:
Last Name *:
Date:
Previous Names:
Date of Birth:
City/Town, State, Zip:
Email Address *:
Drivers License:
Phone Number:

Educational Background:

College:
College Class Year:
High School:
High School Class Year:
Organizations (e.g. Key Club, Circle K, etc):

Employment:

Current Employer (if any):
Position:
Supervisor's Name, Phone #:

Background Info:

Have you ever been convicted of a crime? *:
Have you ever been investigated or the abuse or neglect of an individual? *:

Additional Questions:

How did you hear about PSL Services/STRIVE?:
Why are you interested in volunteering?:
What programs of PSL Services/STRIVE are you interested in volunteering for?
What are three words that best describe you?:
Are there any services you could offer to PSL Services/STRIVE? (sewing lessons, yoga, etc.):
References (please list 3, including phone numbers and email addresses)
Name :
Relationship:
Phone:
Email:
Name :
Relationship:
Phone:
Email:
Name:
Relationship:
Phone:
Email:

Photo Release:

Pictures of volunteer (s)’s activities may be taken and used for publicity purposes including but not limited to publications in commercial periodicals and program newsletters.:
initials of volunteer or guardian if under 18

Applicant Agreement:

I hereby certify that the facts set forth in and above the volunteer application are true and complete to the best of my knowledge. I hereby authorize you to make any investigation of any personal employment history record including the use of investigative agencies or bureaus of your choice. This report may include information as to your character, general reputation, personal characteristics; criminal and motor vehicle record checks will be performed. I authorize previous employers, schools which I attended, and character references to provide information pertaining to my contact with them. I understand that falsified statements or material omissions on my application shall be considered sufficient cause for dismissal.
Signature *:
Date: