Volunteer Application

Date(Required)

Name(Required)

First Middle Initial Last

Address(Required)

Street Address Address Line 2 City State ZIP Code

Home Phone

Cell Phone

Email(Required)

Parent/Guardian Name

If volunteer is under 18 years old.

Parent/Guardian Phone

If volunteer is under 18 years old.

Highest Level of Education(Required)

Volunteer/Work Experience(Required)

You can add more entries by clicking the + button.

Organization

Position/Duties

Start Date

End Date

What interested you in volunteering with Pleasant Valley Connection?(Required)

Are you required to volunteer? If yes, please explain.

Have you ever been convicted (found guilty) of a crime (including probation(s) before judgement), or are there any pending criminal charges awaiting a hearing in a court of law? Do not list any criminal charges for which records have been expunged.(Required)

Yes

Please describe all convictions, when they occurred, the facts and circumstances involved and disposition.

When are you available to volunteer?(Required)

Specify Days of the Week & Hours

Proposed Start Date

Proposed End Date

Type of volunteer work you are interested in performing(Required)

Tutoring Subject

Please specify the subject(s) your interested in tutoring.

Other Volunteer Work

References

List 2 persons, not related to you who have knowledge of your qualifications and would be willing to serve as references.

Reference Name 1(Required)

Reference Phone 1(Required)

Reference Address 1(Required)

Street Address Address Line 2 City State ZIP Code

Reference Name 2(Required)

Reference Phone 2(Required)

Reference Address 2(Required)

Street Address Address Line 2 City State ZIP Code

Statement of Understanding

I certify that all information is true and has been given voluntarily. I understand that this information may be disclosed to any party with legal and proper interest. I release the agency from any liability whatsoever for supplying such information. Upon being offered a volunteer position, I understand that I may be required to provide additional information pertinent to the position for which applied.

Applicant’s Signature(Required)

Parental Signature

If applicant is under 18 years old.

As a volunteer with Pleasant Valley Connection, Inc., I agree to abide by all applicable rules and regulations of the agency. I understand that I will receive no monetary benefits in return for my volunteer service and that Pleasant Valley Connection may terminate this agreement at any time without prior notice for any reason. I hereby authorize Pleasant Valley connection to check my references, and I understand that a criminal background check may be required.I certify that my answers on this application are true and complete and that I have not knowingly withheld any information that might, if disclosed, affect my application unfavorably. I understand that any misrepresentation or omission of facts on this application could be cause for rejection of this application or dismissal.I understand that after I submit my application, it will be reviewed and my eligibility for volunteer work will be determined. I agree to an interview with the Executive Director or designee and orientation and training to perform my volunteer role.I herby Release and Waive liability against Pleasant Valley Connection, Inc., a non-profit corporation, its directors, officers, employees and agents, its successors and assigns, for injuries or illness that I may suffer in connection with any volunteer work for Pleasant Valley Connection, Inc. I agree that this release is as broad and inclusive as permitted by the laws of the State of South Carolina.

Volunteer Signature(Required)