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Over 18 Volunteer Application

First Name
Last Name
Country
Address Line 1
City
State
Postal Code
Country
Address Line 1
City
State
Postal Code
Have you ever lived outside the state of Ohio?
Marital status
Country
Address Line 1
City
State
Postal Code
Do you have children?
Country
Address Line 1
City
State
Postal Code
May we call you at work?
Phone Number
ext Extension
Country
Address Line 1
City
State
Postal Code
So you have any disabilities?
Do you have any communicable diseases?
Education
Country
Address Line 1
City
State
Postal Code
Have you done volunteer work before?
Do you prefer to mentor a boy or girl?
Do you have a valid drivers license?
Do you own a vehicle or have access to transportation?
Do you have automobile insurance?
Have you ever been arrested or detained as a juvenile or adult?
Have you ever been on probation?
Have you ever been arrested for a OVI? (Operating a Vehicle under the Influence of Alcohol and/or Drugs)
Have you had any motor vehicle violations?
Would you object to a criminal background check regarding your record?

Military Record
Have you served in a branch of the military?


References

Please list two (2) references (must be age 18 and older, no relatives) who have known you for at least two (2) years. 

Reference 1
First Name
Last Name
Country
Address Line 1
City
State
Postal Code
Reference 2
First Name
Last Name
Country
Address Line 1
City
State
Postal Code

STATEMENT OF UNDERSTANDING

If I am accepted as a mentor with Reach Our Youth (ROY), I understand my obligation to meet with my mentee regularly for a period of at least six months and to inform the agency staff as to the status of my match relationship every month. In addition, I will strive to attend the ROY group activities with my mentee so that we can both enjoy the friendship of other ROY participants. I further agree to accept the supervision of the ROY staff and to discontinue my service if I am requested to do so by the agency. 

Volunteer Signature
By checking the box, it will count as your signature

I hereby grant Reach Our Youth (ROY) the authority to release any information concerning my involvement in the program to any law enforcement or social service agency upon request. 

Volunteer Signature
By checking this box, it will count as your signature