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Fillable Printable Salvation Army Volunteer Application Form - Carolina

Fillable Printable Salvation Army Volunteer Application Form - Carolina

Salvation Army Volunteer Application Form - Carolina

Salvation Army Volunteer Application Form - Carolina

The Salvation Army of Greater Charlotte
Volunteer Application Packet
Date of Application: ________________________________________________
Name:___________________________________________________________
Email: ___________________________________________________________
Group/Organization/Church: _________________________________________
Desired Volunteer Location:
Belmont Community Center
Belmont Boys & Girls Club Booth Garden Senior Living
Boulevard Homes Boys & Girls Club
Center of Hope Boys & Girls Club
Milton Road Boys & Girls Club
Davidson Boys & Girls Club Marsh Road Boys & Girls Club
Administrative Office
614 Neighborhood Outreach
Center of Hope Women & Children’s
Shelter
Have you had spoken with the program director of desired volunteer location? Yes
No
Please print legibly in black or blue pen.
All application information will be kept confidential.
Social Security numbers are required for the background
check but will be stored in a secure location.
Please mail to:
The Salvation Army
Volunteer Services
P.O. Box 31128, Charlotte, NC 28231
or
Fax to: (704) 295-4922
Appl. Initials________
Volunteer Application –
Children and Youth Worker
Date: ________/________/________
Note: This form is to be completed by all applicants for any volunteer position involving supervision or
custody of minors. This application is used by The Salvation Army of Greater Charlotte to help
promote a safe environment for the children and youth who participate in our programs or use our
facilities.
Any applicant who has ever been convicted of child sexual abuse, physical abuse, or domestic
violence should not volunteer service in any activity or program for children or youth. Applicants with
criminal records of other types will be evaluated at the discretion of the officer/administrator in charge.
Any applicant who is a survivor of childhood sexual or physical abuse needs the love and acceptance
of The Salvation Army of Greater Charlotte family. Applicants who have such a history should discuss
their desire to work with minors with the Volunteer Coordinator or appropriate officer/administrator
prior to any participation in a program serving minors.
All applicants for positions involving services to minors must study and agree to obey the guidelines
that are provided for their program and position within the unit.
Please answer each question.
Consistent with relevant law, the information on this application will not be disclosed to unauthorized
persons.
Date:__________________________ Territorial Registry
Approval Number____________________________
(For office use only)
Applicant Identification
Name
________________________________________________________________________________
Last First Middle
Have you used any other names? ____Yes _____No. If yes, please list complete name and dates of
use on the reverse side of this application.
Present Address
________________________________________________________________________________
Street City State Zip
Home Phone (_____) _____________
Work Phone (_____) _____________
Social Security # _________________
Driver’s License _________________
Appl. Initials________
What age of children/youth work do you prefer?
___________________________________________________
Please answer each question. You may use the back of this paper for explanations or you may attach extra
pages. The information on this application will not be disclosed to unauthorized persons.
Yes No
Y N 1. As a Salvation Army worker (employee or volunteer), do you agree to observe all
guidelines and policies regarding working with youth or children?
Y N 2. Have you ever been convicted of a felony?
Y N 3. Within the last two years, have you been convicted of a misdemeanor which resulted in
Imprisonment/jail?
Note: A conviction will not necessarily disqualify you from employment. The applicant
should not disclose any information regarding criminal arrest or conviction records that
have been expunged or sealed.
Y N 4. Have you ever been subjected to expulsion, reprimand, or other discipline by a corps,
church, denomination, or other religious organization for abuse or misconduct involving
children?
If yes, please describe the circumstances and provide the name and address of the
corps, church, denomination, or religious organization with which you were associated at
the time of the incident.
Y N 5. Have you ever been disciplined or dismissed from employment or a volunteer position by
any employer, including charitable and religious organizations, following an allegation of
sexual misconduct, sexual harassment, or other immoral or inappropriate behavior or
conduct?
If yes, please describe the circumstances and provide the name and address of the
employer.
Y N 6. Have you ever been the subject of a complaint or disciplinary proceeding against a
professional license or other license held by you including, but not limited to, a license to
provide child care or similar services?
Name of unit of which you are (check one below): ________________________________________________
a member currently
most recently
I have never been a member of The Salvation Army.
If a member of The Salvation Army, how long have you been attending? ______________________________
Appl. Initials________
List other corps or churches you have attended over the last five years:
Church Name
Area Code and
Phone Number
Contact Person
Approx. Years
Attended
__________________
to ________________
__________________
to ________________
__________________
to ________________
List previous work (corps/church and non-church) involving children or youth. Use a separate sheet of paper if
necessary.
Organization Type of Work
Contact Person/
Supervisor
Area Code and
Phone Number
List gifts, callings, training, education, or other factors that may have prepared you for work with children and
youth. Use a separate sheet of paper if necessary.
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
Employment History
Begin with most recent employer. Attach additional sheet if needed.
Employer Name
Supervisor’s Name
And Phone Number
Dates of
Employment
Title & Duties
Reasons for
Leaving
Appl. Initials________
Please describe your activities during any gaps in employment in excess of three months. Do not include leave
time or time off due to illness or medical treatment.
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
Applicant’s Statement
I hereby authorize all employers, organizations, churches, and other entities and persons identified in
this form to release any information contained in their files or records concerning me.
In consideration of the receipt and evaluation of this application by The Salvation Army, I hereby
release The Salvation Army and any individual, church, youth organization, charity, employer,
reference, or any other person or organization, including record custodians, both collectively and
individually, from any and all liability for damages of whatever kind or nature which may at any time
result to me, my heirs, or family, on account of compliance or any attempts to comply, with this
authorization. I waive any right that I may have to inspect any information provided about me by any
person or organization identified by me in this application. I HAVE CAREFULLY READ THE
FOREGOING RELEASE AND KNOW THE CONTENTS THEREOF, AND I SIGN THIS RELEASE AS
MY OWN FREE ACT.
I understand and agree that it is critical to the mission and ministry of The Salvation Army that all
employees and volunteers conform to the highest standards of safety, interpersonal conduct, and
sexual morality. I affirm that I will strictly comply with The Salvation Army of Greater Charlotte’s youth
ministry policies and procedures, including those concerning child safety and protection, sexual
abuse and misconduct, and interpersonal relationships. I understand and agree that failure by me to
abide by such policies and procedures may result in my immediate dismissal, or disciplinary action,
all in the discretion of The Salvation Army.
My responses above are truthful and accurate. I understand and agree that if they are not truthful and
accurate, The Salvation Army of Charlotte may determine that I am no longer qualified to be
associated with its programs as an employee, volunteer, or in any other capacity.
Applicant’s Signature _________________________________________________
Date ________________________
Print Name _________________________________________________________
Witness ____________________________________________________________
Date ________________________
To be witnessed by a staff member
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