Volunteer Application

Name: MaleFemale

DOB: SSN: (last 4 digits) TDL #:

Address:

Phone: Home Cell E-mail address:

Last or Current School: Status:

Last or Current Employer: Address:

Phone no: Dates Employed: Position held:

Reason for leaving:

Previous Employer: Address:

Phone no: Dates Employed: Position held:

Reason for leaving:

Indicate your status: ParentNon-ParentStudent

Do you have previous volunteer experience? YesNo | If yes, list location and phone number:

Are you currently working as a volunteer? YesNo | If yes, list location and phone number:

Do you have any special skills? YesNo If so, indicate,

Please check where you would like to work:
After-School (3-6pm): Youth SupervisionMath/Reading TutorialsHomework AssistanceClerical/Record-keepingSnacks/Food PreparationDrillsUniformMusicCreative WritingDramaDecorationsField Trip ChaperonArts/CraftsOrganizingGardeningComputersPhotography/VideoEvent PlanningFundraisersPuppetryOther:

Summer Day Camp: Indoor SportsOutdoor SportsClerical/Record-keepingYouth SupervisionField TripsSpeakers BureauSnacks/FoodArts/CraftsTalent ShowClericalPhotography/VideoOther:

Have you ever been arrested or convicted of a felony or misdemeanor other than for minor traffic violations? YesNo

If yes, please indicate the offense/date:

Have you ever been convicted of a crime against children? YesNo

Have you ever worked with children? YesNo If yes, where

What was your position?

List Three Personal References: Name Address (City, State, Zip code) Phone No. Years Known:

Reference 1:

Reference 2:

Reference 3:

CONSENT STATEMENT
I certify that the information in this application is true and correct. I understand that I could be removed from the volunteer position if any information is found to be false. I am aware that all volunteers must abide by the Volunteer Policy, which includes, but not limited to following instructions of the administrator. I am giving consent for Almighty Ministries, Inc. to obtain a criminal background on me, as permitted by local, state or federal regulations. I furthermore understand that a volunteer is an unpaid position without medical/health coverage and that I am responsible for any medical expenses resulting from personal injury while volunteering with AMI. I also understand that while volunteering with AMI, I may have access to records, files and/or facts that are confidential in nature to both the organization, its clients and/or staff and I do agree to maintain the confidentiality of such information. I hereby release forever, Almighty Ministries, its staff, volunteers, Board of Directors, or any clients served, financially liable for any injuries that I may incur during my service as a volunteer.

ACCEPTED AND AGREED TO:

MEDIA RELEASE
I give my consent to participate in the production of videos and/or media to be used in or for educational or public information purposes. I hereby relinquish all rights and interests whatsoever in any media material regardless of form, resulting from my participation in Almighty Ministries, Inc. I understand that Almighty Ministries, Inc. has the right to use such media in any way it deems, so long as such media are not used as the basis of or for purposes of displaying, creating, developing, producing or promoting any sexually explicit material.

ACCEPTED AND AGREED TO: