Our House Volunteer Application
Email *
Last Name *
First Name *
Middle Name *
Other names used:
Names you are 'also known as'
Date of birth
MM
/
DD
/
YYYY
Home Address/City/State
Phone number
Email
Drivers License number (required for all center volunteers to complete background check)
Current Employer
Preferred method of contact and time of day (text/email/phone)
Experience working with youth
Why are you interested in this position and what skills or classes would you like to teach?
How will you value the culture and diverse backgrounds that youth bring into Our House and your work with youth and families?
What is your approach to conflict resolution and how can you support youth to develop healthy communication skills?
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?
Clear selection
Please explain any YES answers below:
Personal Reference *
Please provide Name, phone number and email for each contact. List contacts on separate lines.
Emergency Contact Name and Number *
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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