Ymca Of Austin Volunteer Application Form

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YMCA OF AUSTIN Volunteer Application
Please Print Clearly
Date:___________ Position Desired: _________________ Preferred YMCA Location: ________________
Name: _______________________________________________ Telephone:______________________
Address: _____________________________________________________________________________
City:_____________________________________________ State:________ Zip Code: _____________
Emergency Contact Name:________________________________ Telephone:______________________
Current Occupation: _________________________________________ Employed Since:_____________
Place of Employment: ___________________________________________________________________
Address: _____________________________________________________________________________
City:_____________________________________________ State:________ Zip Code: _____________
Have you ever been convicted of, been adjudicated with regard to (including an adjudication of delinquent conduct), pled
guilty to, or pled no contest to a criminal charge, or have you ever received probation or deferred adjudication for a criminal
charge? (“Conviction” includes sentenced to confinement, paid fine, served time, placed on probation (including deferred
adjudication) and paid court-ordered restitution.) If so, explain below. Note that you will not automatically be disqualified if
you answer “yes.”
 Yes
 No
How many years of previous experience do you have with the subject you will be instructing/facilitating?
What do you hope to gain from volunteering?
What other organizations have you volunteered with (if any)?
What age group do you prefer to work with: ______________________
References: Please list names, occupation and telephone numbers for 2 people who know you sufficiently
well to provide a reference. References will be contacted.
Name
Occupation
Phone Number
I hereby affirm that my answers to the foregoing questions are true and correct and that I have not knowingly withheld any fact or
circumstance that would, if disclosed, affect my application unfavorably. I understand that any false information submitted in this
application may result in my discharge.
I hereby give my permission for the YMCA of Austin to obtain information, including criminal history. I understand that this
information will be used to determine my eligibility as a volunteer for the YMCA of Austin. I also understand that as long as I remain
a volunteer, I must report any arrest or citation for criminal or felony activity to a YMCA management staff member.
_________________________________________________________________________ __________________________
Applicant Signature
Date
Updated 2/2012

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