Volunteer Application Form (Page 2 of 4) in pdf

Volunteer Application Form Page 2

4. Highest level of education completed:

Middle School

High School or Equiv.

Trade School

Some College

College Graduate

Post Graduate

5. Do you have a child(ren) participating in YMCA programs?

Yes

If YES, what program(s)? ________________________________________________________________________________________________________

6. Do you have experience with YMCA programs?

Yes

7. Please list emergency contact information: _________________________________________________________________________________

Name

Number

8. Have you EVER HAD ANY FELONY convictions?

Yes

If YES:

Date of conviction: _______________________________________________

Specific information related to the conviction: _________________________________________________

Punishment imposed: _____________________________________________________________________

9. Have you ever been refused the opportunity to volunteer or have you been removed from volunteering with any

other agency?

Yes

If YES, on an additional sheet of paper, please list all such organizations and explain the

circumstances as to each refusal or removal.

10. Please list the names, occupation and telephone number of 3 references who know you sufficiently well to

provide a reference. Please include 1 relative. References may be contacted.

Reference 1

Reference 2

Reference 3

Name

Relationship

Phone

Street

City

State/Zip

* A criminal records check will be conducted on all volunteers prior to beginning their volunteer

service. Authorization forms may be obtained from your YMCA supervisor. The YMCA reserves the

right to decline volunteer service based on the results of the criminal records check.

Volunteer Application Form Page 2