Voices for Children Advocacy Center Volunteer Application
Sign in to Google to save your progress. Learn more
Voices for Children has the right to reject any applicant found to have been convicted of or having charges pending for, a felony or misdemeanor involving a sex offense, child abuse or neglect, or related acts that would pose risks to children. *
By initialing below, you understand the above statement
First Name *
Middle Name
Last Name *
Maiden name or alias
What is your date of birth? *
MM
/
DD
/
YYYY
Ethnic Background (Completion Optional)
The following information is used to determine diversity of Voices for Children Volunteer
What is your gender? *
Address *
City *
State *
Zip Code *
Telephone *
Email Address *
Please list your areas of interest *
Required
List current and prior volunteer experiences
Education
Highest level of education, if applicable list your degree.
Highest Level of Education
Field of Study
Employment
Past Employment, position, dates (last 5 years)
Emergency Contact (First and Last Name, Home Address, Telephone, Email)
References
Due to the sensitive nature of our work, we request three professional, non-relative references.
Reference 1 Name and Phone Number *
Reference 1 Email Address
Reference 2 Name and Phone Number *
Reference 2 Email Address
Reference 3 Name and Phone Number *
Include Phone and E-mail
Reference 3 Email Address
How did you learn about volunteer opportunitites at Voices for Children Advocacy Center?
Do you have any physical limitations? *
If yes, select other
Required
I hereby authorize Voices for Children Advocacy Center and it’s agent(s), to request and receive any and all background information about me, including without limitation, my criminal history and my driving record. I understand that background information received from reporting agencies may include arrests, convictions, plea bargains, deferred adjudications, delinquent conduct committed while a juvenile, expungement and investigations. I further release Voices for Children Advocacy Center and its agents, employees, personnel or representatives from any and all claims and liability arising out of the request for this information.
Clear selection
Have you ever been convicted of a crime? *
If yes, please list offense, date and disposition
Have you ever had any felony or misdemeanor charges pending against you? *
If yes, please explain
Have you ever had a personal protection order (PPO) against you? *
If yes, please explain
Have you ever been involved in the abuse or neglect of a child or adult? *
If yes, please explain
Have you ever been involved with a protective service agency? *
If yes, please explain
Have you lived in Michigan for the past 5 years? *
If no, please list the state and years of residence by selecting other
Are you willing to sign a release of information of any and all criminal records, any and all CPS history, and sign a confidentiality disclosure? *
Required
By initialing here, you agree to notify Voices for Children of any pending felony or misdemeanor charges within 10 days after first date of service. *
Please type your initials here.
In consideration of the acceptance of my volunteer services for Voices for Children Advocacy Center, I do hereby, for myself, my heirs, executors and administrators, waive, release and forever discharge any and all rights and claims for damages which I may have with Voices for Children Advocacy Center, its board of directors, staff, or its agents.
Clear selection
I understand a liability waiver and photo release will be required to be signed prior to your volunteer assignment.
Clear selection
I give permission for any photograph, video tape or any other form of audio visual record of myself volunteering for Voices for Children Advocacy Center to be used by Voices for Children Advocacy Center.
Clear selection
Submit
Clear form
Never submit passwords through Google Forms.
This form was created inside of Voices for Children Advocacy Center.

Does this form look suspicious? Report

Google Forms