Itawamba Crossroads Ranch Volunteer Information Sheet
Email address *
Date *
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Name *
Spouse
Phone number *
Mailing Address *
In addition to your formal education, do you possess any talent or skills that might be beneficial to Crossroads? (i.e., floral designer, master gardener, artist, retail sales, speaker, teacher, etc.)
How did you find out about volunteer opportunities at Crossroads? *
Required
Please select your areas of interest: *
Required
BACKGROUND INQUIRY AGREEMENT
Due to the nature of the disabilities of the residents of the Crossroads Community, it is out policy to provide a safe and secure environment. For this reason we ask you to complete the questions below. By COMPLETING AND SUBMITTING this statement, you agree to the investigation of any and all statements included in the form and declare that they are true and complete. Further, you understand background investigations may be conducted and that any misrepresentation, falsification or willful omission of information contained on this form shall be sufficient reason for refusal of your volunteer services.
SS#
Signature
Driver's License #
Date of Birth
MM
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Employer
Job Title
Have you ever been convicted of a criminal offense other than a minor traffic violation?
Clear selection
If yes, please explain:
THANK YOU FOR VOLUNTEERING!
Contact: xroadsranch@gmail.com or 662-585-3334
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