Cuts 4 a Cause Hair Restoration Certification Program Application

Name*

First NameLast Name

Last 4 of Social Security #*

Driver's License #*

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Phone Number

Area CodePhone Number

Email

example@example.com

18 years of age or older?

YesNo

If not, then please list age:

Previously volunteer with Maggie's Wigs 4 Kids of Michigan?

YesNo

If yes, please list dates from ____________ to ____________.

Have you ever been convicted of a crime?

YesNo

If yes, please explain:

Are felony charges pending against you?

YesNo

If yes, please explain:

Answering yes to the above two questions does not necessarily preclude applicant from volunteering/employment.

Are you able to full perform the functions of the job(s) for which you wish to volunteer/apply for?

YesNo

If no, please explain:

Availability to volunteer: 1 volunteer per class hour/completed monthly (please list days & times):

Are you legally eligible to work in the USA?

YesNo

Do you have transportation?

YesNo

School Level: Please list the name of your school, years attended and if you graduated the following: high school, college, cosmetology school, etc.

Work History: Please list (starting with the most recent) two references from employment. This should include the name of the company, name of supervisor, start & end dates, address of company and phone number. Please confirm if we have permission to contact them.

Please list three personal references (include name of contact, address and phone number. We ask that you confirm if we have permission to contact them.)

"Cuts 4 a Cause" Hair Restoration Certification Program Agreement

I certify that the facts set forth in this application training/volunteering, in my resume and in the other materials I have submitted are true and complete. I understand that the submission of any false, inaccurate or misleading information in connection with my application will result in immediate discharge at any time thereafter.

I hereby authorize Maggie's Wigs 4 Kids of Michigan to contact all of my former and current employers, educational institutions and any other references I have provided regarding myself and my performance record, work, academic or miltary experience. I also hereby release Maggie's Wigs 4 Kids of Michigan and its employees, officers, Board of Directors, and agents, and all of my former and current employers, educational institutions, and the other references I have provided, from any and all liability and damages for releasing or using information concerning me and my performance record and work, academic and/or military experience. I also hereby waive any right under the Bullard-Plawecki Right to Know Act, 1978 PA 397, to receive written notice from Maggie's Wigs 4 Kids of Michigan, or any former or current employer, that disciplinary reports, letters of reprimand, or other disciplinary action taken against me while employed, will be or have been disclosed to a third person or entity.

I also understand that Maggie's Wigs 4 Kids of Michigan may, in its sole discretion, conduct or have conducted by an individual or entity of its choice, a conviction-only criminal background history search on me. I hereby consent to this search being conducted and to the disclosure of the results of that search by the individual or entity conducting the search to Maggie's Wigs 4 Kids of Michigan. I further hereby release the individual or entity conducting the search, Maggie's Wigs 4 Kids of Michigan, and its employees, officers, Board of Directors, and agents, from any and all liability, claims, and damages, including but not limited to, claims for releasing or using any information revealed as a result of this search. I also understand and acknowledge that false information provided by me or criminal convictions will result in disqualification from volunteering with Maggie's Wigs 4 Kids of Michigan.

I hereby consent to having a physical and/or mental examination(s) and/or test(s), including testing for illegal drugs, conducted by a physician or other professional of Maggie's Wigs 4 Kids of Michigan's choice, and understand that any offer to volunteer is conditioned upon the results of this examination(s) and/or test(s).

I agree not to commence any action or suit relating to my volunteerism/employment with Maggie's Wigs 4 Kids of Michigan more than 30 days after the date of termination of such volunteerism/employment, and to waive any statute of limitations to the contrary.

I will abide by all the policies, rules and regulations of Maggie's Wigs 4 Kids of Michigan.

Certifying Name

First NameLast Name

Date

Signature