Volunteer Information Form Preston Hollow Presbyterian Church
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1
2Please check the program you are volunteering for:
_____ SDC Jr. Counselor
_____ VBS Volunteer
_____ Camp PVN
YOUTH EMPLOYEE/VOLUNTEER INFORMATION FORM
PART I - All information in this section is required to authorize a background check. Since a youth or
juvenile cannot give permission, the authorization must come from the parent or legal guardian. Print only.
Name (last, first, middle, maiden)
If you have ever used another name, please indicate the name and time periods used:
Current Address -
Number
Street
Apartment No.
City
State
Zip
County
How long at this address? _________ Please list fully all other addresses you have had for at least the past 5
years. Continue on another page, if necessary.
Previous Addresses –
Number
Street
Apartment No.
City
State
Zip
County
Number
Street
Apartment No.
City
State
Zip
County
Number
Street
Apartment No.
City
State
Zip
County
Additional Information -
Sex M F Marital Status: Single Married Divorced Separated Widowed
Birth date _____/_____/_____ Place of birth
Ethnicity
Social Security Number ________/_______/_________ TX Driver’s License Number __________________
Place of Employment _____________________________________________________________________
Home Phone __________________________ Work Phone ___________________________ext._________
SIGNATURE REQUIRED IN PART II ON BACK OF THIS PAGE
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