AdultVolunteerApplication
Yourgiftoftimeisthemostpreciouscontributionyoucanmake.Theeffortsofvolunteers,whobringtheirtalents
toyouth,allowsTheGoodFightCommunityCenter’sprogramstobeeffective.
PERSONALINFORMATION:
LastName:____________________________________________MiddleInitial:__________________________
FirstName:____________________________________________________________________________________
StreetAddress:_________________________________________________________________________________
City:_________________________State:______________________ZIP:______________________________
Email:_________________________________________________________________________________________
Phone:__________________________________________Gender:____________________________________
EmergencyContact:____________________________________Relationship:______________________________
Address:______________________________________________________________________________________
City:_________________________State:______________________ZIP:______________________________
PrimaryPhone:_________________________________________________________________________________
SecondaryPhone:________________________________________________________________________________
Checkappropriatebox(es):EMPLOYED[] STUDENT[]
RETIRED[]
EMPLOYER/SCHOOLINFORMATION:
Employer/School:_______________________________________________________________________________
Address:______________________________________________________________________________________
Phone:________________________Maywecontactifnecessary?YES[]NO[]
Title/Position:_______________________________WorkHours:_______________________________________
Arevolunteerhoursrequiredforaclassorforcommunityservicecredit?YES[]NO[]
Ifyes,explain:
Numberofhoursrequired:_______Requireddateofcompletion:________
Nameofcollege/school/organization(ifapplicable):___________________________________________________
Currentgradelevel:_________Graduationyear:__________Major:_______________________GPA:______
PLEASEDESCRIBETHEFOLLOWING:
HowyoubecameinterestedinTheGoodFightCommunityCenter?
Previousorcurrentvolunteerexperience,training,orlicensingthatwouldbebeneficialtoTheGoodFight’s
volunteerwork.
Educationalbackground,hobbies,orspecialinterests:
Languagesspoken(otherthanEnglish):
Wouldyouliketobenotifiedofspecialeventvolunteeropportunitiesthroughouttheyeartodonateyourtimeand
energytoourorganization?YES[]NO[]
1.
2.
3.
4.
5.
Haveyoueverused,orbeenknownbyanyothername?YES[]NO[]
Haveyoueverbeenplacedonprobationorhadacomplaintorpetitionfiledagainstyouasanadultor
juvenile,forotherthantrafficviolations?YES[]NO[]
Haveyoueverbeenconvictedofamisdemeanor/felonyassault,battery,drugpossession,
childabuseorDUI?YES[]NO[]
Haveyoueverbeendismissedfromanyothervolunteerprogram?YES[]NO[]
Doyouhaveanycontagiousdisease,healthissue,orhistoryofemotionalillnessthatwouldcurrentlyplace
youth,otherworkers,oryourselfatrisk?YES[]NO[]
IfyouansweredYEStoanyoftheabovequestions,pleaseexplainbelow.(PleasenotethataYESanswertoanyof
theabovequestionsmaynotnecessarilyexcludeyoufromvolunteering.)
Ideclareunderpenaltyofperjurythatallstatementsonthisformandattachmentsaretrueandcompletetothe
bestofmyknowledge.Iunderstandthatfalse,misleadingorincompleteinformationshallbecausefor
disqualification.
NOTE:Falsestatementsmadeunderpenaltyofperjurymayalsoresultincriminalprosecution.
NameofApplicant(Print)________________________________________________________________________
Applicant'sSignature_________________________________________________Date:____________________
VOLUNTEERAPPLICANTCERTIFICATIONANDAUTHORIZATION
IherebygiveTheGoodFightCommunityCentertherighttoconductaninvestigationofmybackground.I
understandthattheinvestigationmayincludeinquiryintomypastemployment,educationandactivities,including
butnotlimitedto,criminalbackgroundinformationanddrivingrecord.Ireleasefromallliabilityallpersons,
companiesschools,andcorporationssupplyingsuchinformation.IreleaseTheGoodFightCommunityCenter
againstanyliability,whichmayresultfrommakingsuchinvestigation.Iunderstandthatanyfalseanswers,
statements,implicationsorderogatoryinformationmadebymeorwhichisrevealedasaresultofthisbackground
investigationbasedoninformationsuppliedinanyapplicationforemployment,orotherrequireddocuments,may
becsufficientcausefordenialofvolunteerassignment,ordismissalfromtheprogram.
IunderstandthatTheGoodFightCommunityCentermaycontactmypreviousemployersorreferencesandI
authorizethoseemployersandreferencestodisclosetoTheGoodFightCommunityCenterandreleasethemfrom
anyandallliability,claims,ordamagesthatmaydirectlyorindirectlyresultfromtheuse,disclosure,orreleaseof
suchinformationbyanypersonorparty,whethersuchinformationisfavorableorunfavorabletome.
FullNameofApplicant(Print)______________________________________________________________________
Applicant'sSignature____________________________________________________________________________
DateofBirth:_____/_____/_____SocialSecurityNumber:______-______-______
Driver'sLicenseNumber:__________________________________________________________________________
State:____________ExpirationDate:______________________________________________________________
TheGoodFightCommunityCenter
Ourcharitablemissionistoprovideat-riskanddisadvantagedyouthwithhope,encouragementandasafe
environmenttodeveloppersonalgoals,disciplineandvaluesfreefromjuveniledelinquency,substanceabuse,
truancy,crime,gangactivitiesandotherdifficultchallenges.
Ourvisionistoinstilldisciplineandvaluesamongat-riskanddisadvantagedyouth,toliftthemoutofpoverty,to
providethemwithtrainingandopportunities,andtomotivatethemtobecomeproductivemembersofsociety.
I____________________________,herebyunderstandandagreewiththisMission/VisionStatement.
Applicant’sSignature_______________________________________________Date:_______________________