Volunteer Application

 

On the lines provided below, tell us which agency you would like to volunteer with: 1 = first choice, 2 = second choice, 3 = third choice. If you have one agency that you are certain you want to volunteer with please do not list a second or third choice. If you don't don't know where you would like to volunteer, please skip this line.

 

1.___________________ 2.______________________ 3._____________________

 

Special interests or hobbies: ____________________________________________________________________________

____________________________________________________________________________________________________

Are you able to volunteer with more than one agency at a time? Yes / No (please circle your answer)

 

Last Name:_____________________ First Name:_______________________________ MI:_____________

(If under 18 years of age please attach signed parental consent form to your application.)

 

Address:_________________________________________________________________________________

 

City:________________________________                                                 Zip Code:____________________

 

Date of Birth:_________________________  Social Security #:________________________________

                                                                                    (Do not fill in SS # until you are in the registration area.)

Phone #:_______________________

 

Emergency Contact Name and Phone Number:__________________________________________________

 

Background Information: Circle yes or no to the following questions.

1. Have you ever been convicted of a crime?     YES / NO  If yes, please explain:________________________

_____________________________________________________________________________________

 

2. Do you have a valid TN Driver’s License?    YES / NO

 

References: List 3 people not related to you:

Name:

Phone #:

         Years Acquainted:

 

 

 

 

 

 

 

 

 

 

Please read carefully before signing:

I hereby give my consent for Sevier County’s Promise (SCP) to make inquiry to ascertain information concerning my background. I understand that once my background check is completed SCP will provide this application to one of the approved agencies I listed for volunteerism. My information will be not be sold or shared for any reason.

 

Signature:______________________________________ Date:_____________________________

 

 

Thank you for signing up to make a difference! You will be contacted soon!

For more information or questions about SCP please contact Kim Loveday at 428-7999.

www.seviercountyspromise.org