<p>Volunteer Application</p><p>Contact Information</p><p>Name</p><p>Street Address</p><p>City ST ZIP Code</p><p>Home Phone</p><p>Cell Phone</p><p>E-Mail Address</p><p>Sex/Race</p><p>Availability During which hours are you available for volunteer assignments?</p><p>Monday Tuesday Wednesda y Thursday Friday</p><p>Interests Tell us in which areas you are interested in volunteering</p><p>___ Service Learning Course:______Number of Hours Required:______Date to be completed:______</p><p>___ Court Ordered City/County of offense:______Number of Hours Required:______Date to be completed:______</p><p>___ Club/Organization Name of club/organization:______</p><p>___ Personal satisfaction</p><p>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.</p><p>Previous Volunteer Experience Summarize your previous volunteer experience.</p><p>Prior/ Present Experience working with children Summarize experience working with children.</p><p>Hobbies Summarize your hobbies. Background Check Information</p><p>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</p><p>( ) 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</p><p>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.</p><p>Name (printed) Signature Date</p><p>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.</p><p>Thank you for completing this application form and for your interest in volunteering with us. The Positive Place For Kids</p><p>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.</p><p>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</p><p>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. </p><p>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. </p><p>Staff and Volunteer Information Sheet</p><p>(Must collect on every staff and volunteer)</p><p>Please circle or provide your answers below:</p><p>School Year: Sex: M F Race: </p><p>Report Period: 1st, 2nd, 3rd, or 4th quarters </p><p>Name:</p><p>Full time/ Part time</p><p>Role in program: aide, teacher, program administrator, clerical, evaluator, finance, counselor, transportation, food service, other </p><p>Do you work with/without kids?</p><p>What is your school day role? Administrator, Teacher, Teachers Aide, Food Service, Other, None</p><p>How are you paid? 21 CCLC grant, SAC grant, Title One, Not paid, Non-grant funded</p><p>Education Level: Less than high school, High school diploma or GED, Some college, AA, BA, BA, BS, </p><p>MA, MS, or something higher</p><p>Staff Classification: School day teacher, Administrator, Youth development worker (college degree), </p><p>Non-teaching school staff, College student, High school student, Community member, Other</p><p>Do you work in the school year, summer, or both?</p><p>Please list any national conferences you attended: Child abuse check completed and results:</p><p>TB test completed and results:</p><p>Certifications: (please list your CDA, YDC, CPR instructor class, CPR and first aid class completed, or any other certifications you have). </p>