Fillable Printable 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

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

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