Volunteer Application s7

Volunteer Application

Paraquad seeks enthusiastic individuals to help with a variety of tasks both inside and outside our office.

Street Address City, State, Zip Phone Email

What volunteer position are you interested in at Paraquad? Please do not write “any.” Visit www.paraquad.org and look under “How to Help”, then “Volunteer” for a list of volunteer positions.

Why do you want to volunteer at Paraquad?

What volunteer skills do you currently have?

Are there any volunteer skills that you want to learn?

Please list the days of the week and times that you are available to volunteer?

Additional Information: I understand that if I accept a volunteer position with Paraquad, I may not accept payment for my services. I am willing to participate in trainings as applicable. I understand that it is Paraquad’s policy to register volunteers and employees with the Missouri Department of Health and Senior Services Family Care Safety Registry. Prospective volunteers will receive consideration without regard to race, color, religion, age, sex, pregnancy, sexual orientation, gender identity disability or veteran status.

Signature Date

Thank you for your interest in becoming a part of the Paraquad team!

Return this form by e-mail [email protected], by fax 314.289.4201 or by mail: Paraquad, 5240 Oakland Avenue, Saint Louis, MO 63110 CONSENT TO BACKGROUND SCREENING

Will you consent to a pre-placement criminal record check?  Yes  No Will you consent to a closed records check?  Yes  No

Name Date of Birth

Address

Phone Number Social Security Number

List ALL aliases you have ever used (including maiden names and all married names):

List ALL social security numbers you have ever used:

DISCLOSURE OF BACKGROUND

Have you ever been convicted of a crime in this or any other state? Yes  No List ALL criminal convictions, findings of guilt, please of guilty, and pleas of nolo contendere. Do not list minor traffic offenses such as speeding tickets or parking tickets. (Use the back of this form or additional paper if necessary). Due to regulations from our funding sources, Paraquad, Inc. will NOT accept individuals listed on the Employee Disqualification List (EDL) in any capacity. Paraquad, Inc. will ONLY accept individuals with no criminal history listed on the Family Care Safety Registry (FCSR) background check. No individual with a Class A or B Felony or Abuse/Neglect finding listed on the FCSR results will be accepted. Signature of Applicant ______Date______

Return this form by e-mail [email protected], by fax 314.289.4201 or by mail: Paraquad, 5240 Oakland Avenue, Saint Louis, MO 63110