Application Form For Volunteer (Page 4 of 4) in pdf

2011

Statement of Volunteer Applicant

In the Southeastern Indiana YMCA’s efforts to attract the highest quality volunteer staff, I have been advised

that, as a part of the application process for volunteer service with the YMCA, an extensive inquiry will be

made concerning my prior activities, character, and health, and I fully consent to and authorize all such

inquiries.

If the Southeastern Indiana YMCA accepts my volunteer service, I will comply with all policies set forth in the

volunteer handbook and with other policies established from time to time by the organization. I authorize the

YMCA to request my employment record from any former employer(s). I further understand that inquiries

may be made concerning my background, experiences, and prior employment. I hereby waive any right to

claim that any request or investigations an invasion of my privacy, since it is made with my consent and it is in

my interest that I be considered for volunteer service. I understand that my continued involvement as a

volunteer is contingent upon a clean criminal history background check. I understand that for some volunteer

assignments, health screenings are required by law, and such assignments my involvement as a volunteer will

be contingent upon passing the health screenings or otherwise meeting licensing standards.

I understand that it is this YMCA’s policy to secure conviction-only criminal history information as a part of

the screening process of volunteers. I have provided the following information for the sole purpose of the

YMCA’s obtaining a conviction-only criminal history file search. I understand that the Southeastern Indiana

YMCA does not condone child abusers and that the Southeastern Indiana YMCA will be seeking information

in my background related to child abuse.

I certify that all statements made by me on this application are true to the best of my knowledge and that I have

withheld nothing that would, if disclosed, affect this application unfavorably. I understand and agree that any

misrepresentation or omission of facts would exclude my being considered for volunteer service or, after my

service begins, may cause for termination.

I understand that the YMCA will take seriously any allegations or suspicions of child abuse and will report

such allegations to the police and state agencies for investigation.

I also understand that the YMCA strongly discourages any fraternization outside of YMCA programs between

volunteer staff members and youth participants. I understand that if a volunteer wishes to fraternize due to a

family relationship or longstanding friendship with a participant or participant’s family, such fraternization

should be disclosed to the volunteer’s immediate supervisor. Furthermore, it should not take place without the

presence of another adult.

I understand and agree that if my service as a volunteer is accepted, there is no contract period for volunteer

service and my volunteer service would be solely “at will”, giving either me or the YMCA right to terminate

my volunteer service at any time without liability or obligation.

I hereby acknowledge that I have read and understood the above statement and that I voluntarily sign this application.

Signature of Applicant _________________________________________________ Date: ____________

Signature of parent or guardian if applicant is under 18 _________________________Date: ____________

Application Form For Volunteer Page 4