Adult Volunteer Application Name First Last Address Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code PhoneCellBirth Date Email Would you like to be notified about special events, food pantry needs, coupons, etc.?YesNoEducationOccupationEmployerProfessional LicensesDays & Times I'm available to Volunteer: Saturday Monday Tuesday Wednesday Thursday Friday Are you required to complete volunteer hours?YesNoHow Many?Please check the areas you are interested in for volunteering Administrative Assistance/Food Pantry Health Center Special Events Thrift Store Professional Reference NameProfessional Reference PhoneProfessional Reference Address Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Personal Reference NamePersonal Reference PhonePersonal Reference Address Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Emergency Contact NameEmergency Contact PhoneIt is possible that a background check may be conducted prior to your volunteer involvement. By submitting this form, you are giving your consent for a background check.Have you ever been convicted of a crime other than a minor traffic ticket?YesNoIf yes, please explainHave you ever been convicted of a felony?YesNoIf yes, please explainI declare that all the foregoing statements are true and correct to the best of my knowledge and I understand that if any false information, omissions or misrepresentations are discovered, my application may be rejected and, if I am employed by Rockwall County Helping Hands (RCHH) my employment may be terminated at any time. In consideration of my employment, I agree to conform to the agency’s rules and regulations, and I agree that my employment/volunteer role can be terminated, with or without cause, and without notice. I authorize RCHH, Inc. to conduct a background check, including criminal history and driving record; and to contact my present and past employers, schools, and references to determine my suitability for employment/volunteer. I hereby release RCHH from all liabilities resulting from these inquiries.I Agree To The Above TermsYesNo
