Fill out This Application Completely and Thoroughly

Date Received:______

Time Received:______

VOLUNTEER APPLICATION

PLEASE PRINT ALL ANSWERS Fill out this application completely and thoroughly

Last Name: ______First Name: ______MI: ______

Mailing Address: ______City: ______State:___ Zip:______

Physical Address: ______City: ______State:___ Zip:______

Home Phone: ______Work Phone: ______Cell Phone: ______

Email Address:______

List Other Names You Have Been Known By: ______

List All Previous Addresses In The Past 2 Years:

Address ______City ______State _____How Long _____

Are you a citizen of the United States of America? Yes _____ No ______

Current employer:______Length of Time:______

Do you have a relative who attends the Club? If so, please list name: ______Have you volunteered with this organization previously? Yes _____ No ______If “yes”, please complete information below.

Month/Year of volunteer time: ______Duration of volunteer time: ______Program/position volunteered for: ______Month/Year of volunteer time: ______Duration of volunteer time: ______Program/position volunteered for: ______www.bgcfarmington.org All volunteer applicants must complete a background check prior to being approved for volunteering:

Have you ever been convicted of a felony? Yes _____ No ____ If yes please provide reason for conviction, the state where the conviction took place and the date:

______State ____ Date ___/___/___

Have you ever been charged with child molestation or child abuse? Yes _____ No ____

If yes please state the details of the charge. ______

List the State and County where you were charged. ______Date of Charge ___/___/___

Are you on probation? Yes _____ No ____ Do you have any traffic violations in the last 3 years? Yes _____ No ____ List how many ____

What position/season are you applying for? ______If you are NOT applying to coach, please list your availability:______If you are NOT applying to coach, please list your qualifications or previous experience for this position: ______Highest level of education completed: 10:__ 11:__ 12:__ GED:__ Some college:__ 2-y r:__ 4-yr:__ Are you applying for this position from another program (e.g. San Juan College, High School, etc.)? Yes _____ No ____ Please state which one: ______If applying for a coaching position, please state the school and grade you wish to coach: ______

Do you have a relative you wish to include on your team? Yes _____ No ____ If yes, please list their name: ______

Will you be coaching together with anyone? If so, please list their name: ______

www.bgcfarmington.org I ______authorize law enforcement or any other agencies to release to the Boys & Girls Club of Farmington any information they have on my background including past criminal conduct on my part. I hereby waive claims to confidentially. This release includes any information on my prior rap sheet.

Signature: ______

Printed Name: ______

Social Security Number: ______

D. L. Number and State: State: ______Number: ______

Date of Birth: ______

For Office Use Only:

Applicant review:

On Time: ______yes ______no

Notes: ______

Position or team: ______

Background check completed: ______Clear: ______Approved: ______Sex Offender check completed:

National : ______Clear: ______Approved: ______

State: ______Clear: ______Approved: ______Date and Time Received: ______

www.bgcfarmington.org The Boys & Girls Club of Farmington is a private, non-profit organization that is privately funded and works with the community to raise funds to continue our services. Two ways you can help with no cost to yourself are listed below.

Sign up with and make money for this Club every time you shop on-line at any of their 700+ stores. There is no cost to you.

1. Click on the link above to go to the iGive.com website. 2. Step 1: Find and select your cause. Select New Mexico and Children/Youth in the drop down boxes. Type "Farmington" in the appropriate box. 3. When the Boys & Girls Club of Farmington comes on the screen, click on the name. 4. Click the "Select This Cause" box on the right of the screen. 5. Register yourself as a user. 6. Remember to go through this portal whenever you do your on-line shopping.

You can also make $0.01 for the Club on every internet search you do if you use instead of your usual browser. Again, this is FREE to you.

Please visit our website at www.bgcfarmington.org for more information or to register to help.

The Club offers the following programming: Character & Leadership Development Health & Life Skills Goals for Growth SmartMOVES Youth of the Year Smart Girls Teen Supreme Keystone Club T.R.A.I.L. Torch Club Talking with TJ

Education & Career Development The Arts Career Launch Image Makers Dragonfly Quest Music Lessons Goals for Graduation Arts & Crafts Money Matters Power Hour Sports, Fitness & Recreation Project Learn Fitness Authority Girls Club Triple Play Job Training P.A.Y.S. Science/Math Club Presidential Fitness Tutoring Referee Instruction Reading Boys Basketball Library Girls Basketball Global Trippin’ Co-ed Basketball NetSmartz Spirit Squad Digital Arts Coed Volleyball

We offer specialized programming in addition to the items above. We have volunteer opportunities throughout our Club in all areas.