The Positive Place for Kids

Volunteer Application

Contact Information

Street Address

City ST ZIP Code

Home Phone

Cell Phone

E-Mail Address

Sex/Race

Availability During which hours are you available for volunteer assignments?

Monday Tuesday Wednesda y Thursday Friday

Interests Tell us in which areas you are interested in volunteering

___ Service Learning Course:______Number of Hours Required:______Date to be completed:______

___ Court Ordered City/County of offense:______Number of Hours Required:______Date to be completed:______

___ Club/Organization Name of club/organization:______

___ Personal satisfaction

Special Skills or Qualifications Summarize special skills and qualifications you have acquired from employment, previous volunteer work, or through other activities, including hobbies or sports.

Previous Volunteer Experience Summarize your previous volunteer experience.

Prior/ Present Experience working with children Summarize experience working with children.

Hobbies Summarize your hobbies. Background Check Information

Date of Birth Social Security Number Driver’s License and State ( ) Yes ( ) No Have you ever been investigated by the Department of Social Services for Child Abuse ( ) Yes ( ) No Has anyone ever questioned your past experiences with children? Explain if yes is checked above

( ) Yes ( ) No I authorize the Boys & Girls Club to conduct a criminal background screening with the information I Initial______have supplied. ( ) Yes ( ) No I understand that the Boys and Girls Club of the Columbia Area has the right to deny the applicant acceptance into the program and that the agency will not be required to give reason for denying Initial______program participation

Agreement and Signature By submitting this application, I affirm that the facts set forth in it are true and complete. I understand that if I am accepted as a volunteer, any false statements, omissions, or other misrepresentations made by me on this application may result in my immediate dismissal.

Name (printed) Signature Date

Our Policy It is the policy of this organization to provide equal opportunities without regard to race, color, religion, national origin, gender, sexual preference, age, or disability.

Thank you for completing this application form and for your interest in volunteering with us. The Positive Place For Kids

To maintain a high level of professionalism for our program, guidelines are provided below regarding personal dress and appearance. Employees are not only representing themselves, but are a direct reflection of the Boys and Girls Club. Casual attire will generally be considered appropriate dress Monday through Friday, however, there may be occasions when more traditional business attire will be required. The goal of implementing this policy is to offer a greater degree of comfort than is usually associated with business clothing while maintaining a professional atmosphere.

Appropriate casual dress at the Club includes:  Jeans/Denim only is it is of nice quality, free of wrinkles and tears  Dress, khaki or athletic shorts (no shorter than 3” above the knee)  Capri pants  Loafers, leather lace-ups or slip-ons, flats, dress sandals, boots, athletic sneakers if clean and in good condition

Inappropriate attire at the Club includes:  Sweatsuits, sweatpants, sweatshirts  T-shirts and tank tops  Leggings  Backless or spaghetti-strapped tops or dresses  Crop or tube tops  Mini skirts  Sandals such as flip-flops and thongs Casual does not mean sloppy. Clothing should be clean and pressed and without holes or frayed edges. Clothing that is too tight or too revealing is never appropriate. Casual might be more comfortable, but it still requires a comparable degree of neatness and dignity.

These guidelines are not intended to be all-inclusive. Employees are responsible to dress appropriately. Questions should be addressed to a supervisor or the Executive Director before wearing questionable outfits.

Staff and Volunteer Information Sheet

(Must collect on every staff and volunteer)

Please circle or provide your answers below:

School Year: Sex: M F Race:

Report Period: 1st, 2nd, 3rd, or 4th quarters

Full time/ Part time

Role in program: aide, teacher, program administrator, clerical, evaluator, finance, counselor, transportation, food service, other

Do you work with/without kids?

What is your school day role? Administrator, Teacher, Teachers Aide, Food Service, Other, None

How are you paid? 21 CCLC grant, SAC grant, Title One, Not paid, Non-grant funded

Education Level: Less than high school, High school diploma or GED, Some college, AA, BA, BA, BS,

MA, MS, or something higher

Staff Classification: School day teacher, Administrator, Youth development worker (college degree),

Non-teaching school staff, College student, High school student, Community member, Other

Do you work in the school year, summer, or both?

Please list any national conferences you attended: Child abuse check completed and results:

TB test completed and results:

Certifications: (please list your CDA, YDC, CPR instructor class, CPR and first aid class completed, or any other certifications you have).