Gshg Volunteer Application Form – Fill Out and Use This PDF

VOLUNTEER APPLICATION

FOR OFFICE USE ONLY (Membership Manager)

Application date:

Recruited by (staff):

Received via: r Email r Paper r Web

Verified personal data and signature:

PERSONAL INFORMATION (Please print clearly.)

Last Name:

First Name:

Middle Name:

Address:

City:

State:

Zip:

Daytime Phone: ( )

Evening Phone: (

)

Cell Phone: (

)

County/SU:

Email Address:

Gender: rFemale

rMale

Employer:

Position:

Employer’s Address:

Have you ever been a Girl Scout? r No r Yes, as a girl for

years. r Yes, as an adult for

years.

What is the best time to contact you? r Morning r Afternoon r Evening

VOLUNTEER INTEREST

Girls can participate in Girl Scouts in many different ways. How are you able to support them?

PREFERRED VOLUNTEER SERVICE: (Select all opportunities that you are interested in.)

rDirect service (working directly with girls)

Which grade levels are you interested in working with?

r K – 1st Grade: Girl Scout Daisies	r 2nd – 3rd Grade: Girl Scout Brownies
r 4th – 5th Grade: Girl Scout Juniors	r 6th – 8th Grade: Girl Scout Cadettes
r 9th – 10th Grade: Girl Scout Seniors	r 11th – 12th Grade: Girl Scout Ambassador
Troop Support: r Troop leadership team	r Parent volunteer (chaperone, transportation, cookies)

rCouncil and regional area volunteer service (working with council staff and other troops/groups): Special Events: r Activity facilitator r Event planning, set-up, registration, etc.

Specialty:

Participate with Travel Groups: r Chaperone r Trip coordinator r Fundraising

rSpecial Interest Group:

Volunteer (6-8 week opportunity): What is your special interest?

Outdoor Education: r Day/resident camp r Aquatic studies r Environmental education

rSports

GSHG FORMS (8/2012)

VOLUNTEER APPLICATION

PAGE 2

VOLUNTEER INTEREST (CONTINUED)

rIndirect service (not working directly with girls but supporting adults and council staff who work directly with girls)

Working with Adults:	r Coach/mentor	r Fund development	r Adult learning facilitator
	r PR liaison	r Recruiting	r Accounting
	r Trip Planning	r Event Coordination	r Quality Assurance

rService Unit team member/administrative volunteer

r Community Cultivation		r Product Sales
r Customer Service		rInterviewing
rOther (Please specify):
Ideal Volunteering Duration:
r Occasional (e.g., single events)		r Four to six months r Seasonal r One year
r One to twelve weeks

References: List two (2) persons not related to you who are familiar with your qualifications for volun- teering with Girl Scouts. If you have previous experience as a volunteer, one reference should be from that organization.

Name:

Address:

City:

State:

Zip:

Phone: (

)

Relationship:

Name:

Address:

City:

State:

Zip:

Phone: (

)

Relationship:

Girl Scouts of Historic Georgia is dedicated to the safety of the girls and adults in our membership. It is mandatory to complete the following section. Failure to complete this application in its entirety will disqualify your application. This information is confidential and for internal use only.

Has your driver’s license ever been suspended or revoked?	r No	r Yes
Have you ever been convicted of a criminal offense?	r No	r Yes
Have you ever been convicted of a crime involving bounced checks or stolen money?	r No	r Yes
Have you ever been convicted for the use or sale of illegal drugs?	r No	r Yes
Have you ever been convicted of child neglect or abuse?	r No	r Yes
Has anyone in your household been convicted of a felony/crime/child abuse?	r No	r Yes
Is anyone in your household a registered sex offender?	r No	r Yes

If you answered “yes” to any question:

State the offense:

Date of offense:

Location of offense:

Explanation:

Do you presently have a valid Driver’s License? r Yes r No

Driver’s License #

State

Expiration

GSHG FORMS (8/2012)

VOLUNTEER APPLICATION

PAGE 3

Please check one:

rI have visited the following site to complete my background check: https://gshg.volunteerportal.net - (“Historic” is the password.)

Date completed:

Please sign the bottom of this application before submitting it. The screening must be completed before your application will be approved. If you completed the screening online, you do not complete the information below, except for your signature.

rPlease complete my background check.

The following is my true and complete legal name, and all information about it and my background is true and correct to the best of my knowledge. I understand that all inquiries on this form are used for identification purposes only in order to conduct a background check that is being conducted for legitimate business reasons, specifically for volunteer and/or continued volunteer purposes.

* Responses to sex, age, and race inquiries are voluntary, and choosing not to respond will not preclude hire or promotion.

Date of Birth:

Social Security Number:

-

-

Other Names Used (including maiden name):

I have the right to make a request to IntelliCorp Records, Inc., upon proper identification, to request the nature and substance of all information in its files on me at the time of my request, including sources of information, and the recipients of any reports on me which IntelliCorp Records, Inc. has previously fur- nished within the two year period preceding my request.

I certify that all of elements of the personal data I have provided are true, accurate and complete. I un- derstand and agree that any omission, false statement, misleading statement, or answer made by me on my application or any supplements to it and in any interviews will be sufficient grounds for rejection of volunteer application and my discharge after approval.

Signature

Date

Return this application, authorization, and personal data sheet via e-mail or in a sealed envelope marked

“confidential” to your nearest service center to the attention of the Volunteer Management Specialist/Manager.

FOR OFFICE USE ONLY

Background Check Status: r Complete r Inquired r Pending

Background Date:

Criminal Background Result:		r Report Found	r No Report Found
Expiration Date:

GSHG FORMS (8/2012)