Girl Scouts Of Connecticut Application For Volunteer Service Form (Page 2 of 2) in pdf

VOLUNTEER EXPERIENCE–

(List previous Girl Scout or other youth service first.) Please provide accurate and complete information for all volunteer experience

for the last ten years. You may attach additional sheets, if necessary.

Organization’s Name: ______________________________________________________________

Dates: From_________ to __________

Address: ________________________________________________________________________

Positions: ______________________________

Street

Town

City

Zip

Supervisor: ________________________________________________________

Email Address: __________________________________

Responsibilities: ______________________________________________________ Phone Number: (

) ____________________________

Organization’s Name: ______________________________________________________________

Dates: From_________ to __________

Address: ________________________________________________________________________

Positions: _____________________________

Street

Town

City

Zip

Supervisor: ________________________________________________________

Email Address: __________________________________

Responsibilities: ______________________________________________________ Phone Number: (

)____________________________

PERSONAL INFORMATION

Hobbies, skills, training, and educational background – Please describe.

________________________________________________________________________________________________________________________

TRANSPORTING GIRLS:

When transporting girls to planned Girl Scout field trips and other activities that are outside the normal meeting day, time and place, every driver must be

an approved adult volunteer and have a good driving record, a valid operator’s license appropriate to the vehicle, and a registered/insured vehicle.

Girl Scouts of Connecticut requires every driver to complete the Troop/Group Driver Annual Form prior to transporting Girl Scouts. This form must be

completed annually and requires an original signature.

(Volunteer Essentials, Responsibilities of the Volunteer: Girl Scout Safety Guidelines, Travel Safely)



Yes

I will be volunteering as a Troop/Group driver only.

This is an application for a volunteer position with Girl Scouts of Connecticut for which there is no monetary compensation.

In the selection of volunteers, Girl Scouts of Connecticut does not discriminate against any person on the basis of race, color, religion, age, sex, sexual

orientation, marital or civil union status, national origin or ancestry, political affiliation, socio-economic factors, genetic information, learning disability,

physical or mental disability, military status, or any other protected class status.

I understand that it is my responsibility to provide two (2) personal references, none of which are related to me nor reside with me, that will affirm my

ability to work in a leadership role within Girl Scouting. Should the need arise for additional information I hereby authorize you to contact my references.

I further authorize these references to release to you any and all information that they have about me, and I release all parties involved from any liability

arising out of the release of that information.

I understand that criminal background searches/checks are required by Girl Scouts of Connecticut, and I understand that these searches/checks may also

be conducted on other individuals in my household.

I acknowledge that I have received a copy of the Background Search Policy and Procedures for Employees and Volunteers.

I understand, for my application to be considered, that I must complete the Authorization and Consent for Release of Information for Background Search

form. This can be done by utilizing the secure online Background Search process at

or by mailing the

completed form to Girl Scouts of Connecticut, Human Resources Department, 340 Washington Street, Hartford, CT 06106. Please mark the envelope

“Personal and Confidential”.

I understand that if appointed to a volunteer position, I will be required to comply with Girl Scouts of the USA and Girl Scouts of Connecticut policies and

standards; will enroll and maintain current membership with the Girl Scouts of the USA; and will fulfill my responsibilities to the best of my ability.

I understand that any misrepresentation, omission, or falsification of any fact from this application or during any interview will be cause for rejection of this

application or dismissal from volunteer services. I also understand that acceptance for volunteer service is subject to receipt of reference forms or

successful completion of the Volunteer Application Process which includes Background Screening.

Applicant’s Signature

Date

Application for Volunteer Service 11-6-14