Head Start Volunteer Application Form printable pdf download

MONROE COUNTY INTERMEDIATE SCHOOL DISTRICT

Human Resources Department

1101 S. Raisinville Road

Monroe, Michigan 48161

734-242-5799

HEAD START VOLUNTEER APPLICATION

*Application must be completely filled out in order to be considered*

Date: __________________________ Male: __________________ Female: ________________

Name: _________________________________________________ Date of Birth: _______________________

Address: ______________________________ City: ____________________ State: _________ Zip: ___________

Home Phone: ______________________ Cell Phone: ____________________ Race: _______________________

How did you hear about Head Start? _______________________________________________________________

Personal Statement:

In connection with my application to provide volunteer services for Monroe County ISD Head Start, I authorize

Monroe County ISD Head Start to conduct criminal background and reference checks concerning me. I also authorize

Monroe County ISD Head Start to conduct additional background checking, as they may deem necessary to approve

my volunteer service in its programs.

Signature of Volunteer Applicant:__________________________________ Date:______________

Have you ever been convicted of a criminal offense (misdemeanor or felony)? YES/NO

_____________________________ _______________________________ __________________________________

(Date of Conviction)

(Name/Address of Court) (Nature of Offense)

Please indicate which Head Start location you would like to volunteer at:

SMT________________ Jefferson________________ Smith Road________________ Ida________________

When are you available to volunteer? (Enter time of day)

Monday

Tuesday

Wednesday

Thursday

Friday

Morning

Afternoon

Evening

***Staff Use Only (Volunteer Coordinator needs copy of all info.)***

Orientation Date: __________________ TB questionnaire (if applicable)

Building/Classroom: ________________ BCI check (if applicable)

Supervisor: _______________________ Background Permission Signature (On application)

Code of Conduct Form Thank You Given

Statement of Confidentiality Form

Head Start Volunteer Application Form