Volunteer Form
The information on this form will be kept confidential and will help us find the most satisfying and appropriate volunteer opportunity for you. By submitting this form, you are acknowledging that all of the information contained on this form is true and accurate and that you are authorizing the Guernsey County Board of DD to check your references and a complete background check for your criminal history and driving offenses. (if applicable to the volunteer position or service i.e., working unsupervised with an individual with a developmental disability). By submitting this form, you are also verifying that you do not use illegal drugs.
As a volunteer, I under stand that I will be volunteering at my own risk at that the Guernsey County Board of DD, its employees, and affiliates, cannot assume any responsibility or liability for any accident, injury, or health problem which may arise from any volunteer work I perform for the organization.
Name *
Your answer
Date of Birth *
MM
/
DD
/
YYYY
Gender *
Street Address *
Your answer
City *
Your answer
State *
Your answer
Zip Code *
Your answer
Phone Number *
Your answer
Email Address *
Your answer
Do you have a valid (State) drivers license? *
License Number:
Your answer
Vehicle License Plate #:
Your answer
Insurance Company
Your answer
Have you ever been convicted for violation of any laws, traffic or otherwise? *
If yes, please explain
Your answer
Who to notify in case of an emergency *
Your answer
Relation to you *
Your answer
Emergency Contact Phone Number: *
Your answer
Submit
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This form was created inside of Guernsey County Board of DD.