Volunteer Application : Volunteer : Reach Our Youth

Name

First Name *

Last Name *

Date (Required)

Phone

Email (Required)

Address

Country

Address Line 1 *

City *

State/Province *

Postal Code *

How long at this address?

Race

Gender

Previous Address

Country

Address Line 1

City

State/Province

Postal Code

How long at this address?

Have you ever lived outside the state of Ohio?

Yes
No

If so, where and for how many years?

Date of birth

Place of birth

Marital status

Single
Married
Widowed
Divorced

Name of spouse or parent(s)?

Address of the above named

Country

Address Line 1

City

State/Province

Postal Code

Phone number of the above named

If married, your maiden name

Do you have children?

Yes
No

If yes, child names and their ages

Your current place of employment

Current Employment Address

Country

Address Line 1

City

State/Province

Postal Code

Position with current employer

How long have you been employed?

What is your work schedule?

May we call you at work?

Yes
No

If yes, work phone number

ext Extension

Previous place of employment

Previous employment address

Country

Address Line 1

City

State/Province

Postal Code

How long were you employed?

Position at past employer

What is your general condition of health?

So you have any disabilities?

Yes
No

If yes, please explain

Do you have any communicable diseases?

Yes
No

If yes, please explain

What high school did you attended or are attending?

Address of high school

Country

Address Line 1

City

State/Province

Postal Code

What years have been completed?

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If applicable, year of graduation

What college did you attended or are attending?

If applicable, year of graduation

Degree obtained/area of study

If additional education, please list

Please list any previous experience working with youth

Have you done volunteer work before?

Yes
No

What type and where?

What age child do you prefer to mentor?

Do you prefer to mentor a boy or girl?

Boy
Girl
No preference

If you have a preference, please explain

What are your hobbies and interests?

Do you have a valid drivers license?

Yes
No
Yes, but do not drive

Do you own a vehicle or have access to transportation?

Yes
No

Do you have automobile insurance?

Yes
No

If yes, please provide company name

Please describe your past and current use of alcohol

Please describe your past and current use of drugs

Have you ever been arrested or detained as a juvenile or adult?

Yes
No

If yes, please explain

Have you ever been on probation?

Yes
No

If yes, please explain

Have you ever been arrested for a OVI? (Operating a Vehicle under the Influence of Alcohol and/or Drugs)

Yes
No

If yes, please explain

Have you had any motor vehicle violations?

Yes
No

If yes, please explain

Would you object to a criminal background check regarding your record?

Yes
No

Have you served in a branch of the military?

Yes
No

If yes, please provide date of services

If yes, please provide types of duties you held

If discharged, what type?

How did you learn about ROY?

Why do you desire to mentor a child through ROY?

Additional comments or information

Name

First Name

Last Name

Address

Country

Address Line 1

City

State/Province

Postal Code

Phone

Current occupation

Name

First Name

Last Name

Address

Country

Address Line 1

City

State/Province

Postal Code

Phone

Current occupation

Volunteer Signature

By checking the box, it will count as your signature

I understand

Date

Volunteer Signature

By checking this box, it will count as your signature

I agree

Date

Volunteer Application

Education

Military Record

References

Reference 1

Reference 2

STATEMENT OF UNDERSTANDING