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Volunteer Application

Volunteer Application

Please indicate volunteer interest(s):
Tutor/Mentor
Visitation Center
Life Book
Other:

PART I: Personal Information

Date: Gender: Male Female
Full name:
(First Middle Name)
Maiden Name:
Spouse Name: Date of birth:
Home address: City:
State: Zip:
Home phone: Work phone
Cell phone: Email:
Driver’s license number: State issued:

Have you ever been convicted of a crime?
No Yes (Please explain: )
Do you have any health issues or physical conditions that should be noted?
No Yes (Please explain: )
Do you have any mental health issues (current or past)?
No Yes (Please explain: )
Do you have any substance-abuse issues (current or past)?
No Yes (Please explain: )
Do you object to our agency running a background check on you?
No Yes (Please explain: )

Education level:
Language(s) spoken:
Please describe any previous volunteer experience:
What time(s) work best for your schedule?
After school After 5 p.m. Weekends During business hours
Emergency contact:
Phone:
Relationship:
Special training, skills, hobbies
How did you hear about Arizonans for Children?
Friend/relative
Newspaper
AFC Web site
Other Web site
Other:

PART II: Employment History
Please provide employment information for the past five years, with most recent position first. If more space is needed, use an extra sheet of paper.

Would you like us to keep your employer abreast of your volunteer service and achievement? Yes No
Employer
Address
City
State
Zip
Phone
Your Position/Title
Supervisor’s Name
Supervisor’s Position/Title
Dates of Employment (MM/YYYY)
From
To
Employer
Address
City
State
Zip
Phone
Your Position/Title
Supervisor's Name
Supervisor's Position/Title
Dates of Employment (MM/YYYY)
From
To
Employer
Address
City
State
Zip
Phone
Your Position/Title
Supervisor's Name
Supervisor's Position/Title
Dates of Employment (MM/YYYY)
From
To

PART III: Personal References
Please list the names, addresses, and phone numbers of three people you would like to use as character references (only people you have known for at least a year). Include one relative. Any information Arizonans For Children (AFC) gathers from these references will be held as confidential and not released to you, the applicant.

Name:  
 
Address: City:
State: Zip:
Phone: Email:
Relationship How long known
Name:  
 
Address: City:
State: Zip:
Phone: Email:
Relationship How long known
Name:  
 
Address: City:
State: Zip:
Phone: Email:
Relationship How long known

PART IV: Program-Specific Information
Tutor/mentor and Life Book volunteers:

Please list all members of your household (Tutor/mentor and Life Book volunteers only):

Name Gender Age Relationship
Male Female
Male Female
Male Female
Male Female
Male Female

Please rate your comfort level in working with the following age groups (Tutor/mentor and Life Book volunteers only):
1 = I prefer working with this age group 2 = I feel pretty comfortable working with this age group 3 = I feel uncomfortable with this age group

K – 5th grade 6th – 8th grade 9th – 12th grade
Tutor/mentors only: Please tell us about any additional background experience, skills, interests, that you have that might enhance your ability to work with a particular child, youth, or teen:
Life Book volunteers only: Please describe any relevant family history research experience:

Please read this carefully before signing:

Please initial each of the following:

I agree to follow all AFC program guidelines and understand that any violation will result in suspension and/or termination.

I understand that AFC is not obligated to provide a reason for their decision in accepting or rejecting me as a mentor.

I understand I must return all of the following completed items along with this application, and that any incomplete information will result in the delay of my application being processed:

  • Copy of your valid driver's license and proof of auto insurance
  • Information Release Form
  • Personal References Form
  • Interest Survey Form

I have read and understand the program's rules, regulations, and responsibilities for becoming a mentor. If selected, I will follow the policies and procedures of the program and be a dedicated, trustworthy mentor. I agree to the time commitment of 2-3 hours/week for one year.

By signing below, I attest to the truthfulness of all information listed on this application and agree to all the above terms and conditions.

Information Release

Tutor/mentor and Life Book volunteers only: Please mail or fax completed form to Arizonans for Children (AFC).

I, , understand it will be necessary for AFC to conduct a background check regarding my driving record, criminal history, personal references, and employment.
I authorize AFC to obtain any needed information regarding my driving record, legal/criminal history, character references, and employment from any state or federal agency, my employer, and personal references for the purposes of participating in AFC programs.  Further, I provide permission for AFC to conduct the same investigation of my background in previous states in which I have resided.
Further, if I am applying for a program involving a one-on-one match, I understand that information about myself will be anonymously (without my name) shared with a prospective foster youth and his/her parent(s)/guardian(s) to aid in determining a suitable match. Once a match is determined, my identity and any other information known about me may be shared with the youth and parent/guardian to ensure a safe and successful mentor relationship.

Full Name:
Address:
City: State: Zip:
Date of Birth: Current Driver's License No. State:

Please list any other cities, states, and dates of residency during the past 10 years.

City: State: From (mm/year) To (mm/year)



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