Our House Volunteer Application
Email address *
Last Name *
Your answer
First Name *
Your answer
Middle Name *
Your answer
Other names used:
Names you are 'also known as'
Your answer
Date of birth
MM
/
DD
/
YYYY
Home Address/City/State
Your answer
Phone number
Your answer
Email
Your answer
Drivers License number (required for all center volunteers to complete background check)
Your answer
Current Employer
Preferred method of contact and time of day (text/email/phone)
Your answer
Experience working with youth
Your answer
Why are you interested in this position and what skills or classes would you like to teach?
Your answer
How will you value the culture and diverse backgrounds that youth bring into Our House and your work with youth and families?
Your answer
What is your approach to conflict resolution and how can you support youth to develop healthy communication skills?
Your answer
If you answer yes to any of the questions below, please attach a separate sheet with your explanation. The terms “child” and “children” refer to persons under the age of 18.
Yes
No
Have you ever been charged with, arrested for, entered a plea for, or been convicted of any sexual offense or felony?
Has any civil judgment ever been made against you for reasons related to sexual misconduct or child abuse?
Have you ever resigned from employment or been disciplined or terminated by an employer for reasons related to sexual misconduct or child abuse?
Is there anything in your background that would call into question your being entrusted with the supervision, guidance, and care of children?
Have any allegations of child abuse, family violence, or domestic violence been made against you?
Please explain any YES answers below:
Your answer
Personal Reference *
Please provide Name, phone number and email for each contact. List contacts on separate lines.
Your answer
Emergency Contact Name and Number *
Your answer
The information provided by me in this application is correct to the best of my knowledge. I authorize any references or institutions listed in this application to give Our House any information they have regarding my character and fitness for working with children. I also release this information to be used in a criminal background check. *
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