Volunteer Application & Release from Liability
Volunteers are elected into The Arc of Chemung program after careful consideration. Applying for a volunteer position within The Arc of Chemung does not guarantee placement within the organization.
Salutation *
Name (First and Last) *
Your answer
Address *
Your answer
City, State, Zip *
Your answer
Email *
Your answer
What days and/or times are you available to volunteer? *
Your answer
Gender *
Date of Birth *
mo/da/yr
Your answer
How did you hear about The Arc of Chemung?
Your answer
Have you ever been convicted of a misdemeanor or felony in any jurisdiction? *
Do you have any criminal charges pending against you? *
What is the highest level of education completed: *
(If currently a student, please note what grade/year you are currently in.)
Your answer
Are you completing an internship or school-required community service? *
What school is requiring this internship/community service? *
(Indicate n/a if this does not apply to you.)
Your answer
Who is your contact advisor for this internship/community service? *
(Indicate n/a if this does not apply to you.)
Your answer
How many hours do you need to fulfill? *
(Indicate n/a if this does not apply to you.)
Your answer
When do they need to be completed? *
(Indicate n/a if this does not apply to you.)
Your answer
Please list the last three places you have worked and the positions you held. *
Include Employer, Position Held, Reason for Leaving, Phone Number.
Your answer
List any special skills or qualifications which you feel would be beneficial as a volunteer for our organization: *
Your answer
VOLUNTEER AGREEMENT I understand that all information and data about clients, agencies, volunteers, staff and donors of The Arc of Chemung is strictly confidential and may not be discussed outside the office, or with any unauthorized person. Volunteers are subject to a full background screening process. Volunteers are required to have two (2) current ppd (TB results), may have a child abuse clearance check, background check and be subject to fingerprinting. PPd results can be obtained from a physician, school health office or can be obtained free of charge from The Arc of Chemung. Please note: we cannot accommodate requests for Court Mandated Community Service. *
Type your name to electronically sign.
Your answer
Signature of Parent/Legal Guardian if volunteer is under the age of 18. *
(Indicate n/a if this does not apply to you.)
Your answer
I grant full permission to The Arc of Chemung to use any photographs, film, video or audiotapes of my performing volunteer work for any purpose The Arc of Chemung deems appropriate. *
Submit
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service