Carver's Volunteer Registration Form

Name*

First NameLast Name

E-mail*

Birth Date*

MonthDayYear

Phone Number*

Area CodePhone Number

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Availability:*

MorningsAfternoons *This is the only time available to volunteer with Carver kidsEvenings

Driver's License?*

YesNo

License #

License State

If you're a full-time student, name of School/University:

Grade

Current employer:

Employer address:

Contact name:

Volunteer interests*

Are you interested in volunteering at any of our community events?

Food Drive (November)Toy Drive (December)Holiday Party (December)

We are always open to new ideas! If you have one, please elaborate here.

Please list any past volunteer experience. If none, write N/A.*

Is there any reason that you know of why you shouldn't work with children?*

YesNo

If yes, please explain:

Have you ever been convicted of a felony?*

YesNo

If yes, please explain:

Have you ever been convicted of a misdemeanor?*

YesNo

If yes, please explain:

Have you ever been charged with ANY offense involving a child/minor?*

YesNo

If yes, please explain:

Has your driver's license ever been revoked or suspended?*

YesNo

If yes, please explain:

I understand that:

The information that I have provided may be verified, if necessary, by contacting persons or organizations named in this application or by contacting any person or organization that may have information concerning me. I hereby release and agree to hold harmless from liability any person or organization that provides information. I also agree to hold harmless the Carver Foundation of Norwalk, Inc. and the officers, employees, and volunteers thereof.

I certify that all information provided on this application is true and complete. I understand that falsification or significant omissions of any information may be considered justification for dismissal if discovered at a later date. Every effort will be maintained to provide confidentiality
of personnel information in this application.

The Carver Foundation of Norwalk, Inc. places an emphasis on pluralism, actively seeking members from every racial, ethnic, religious and socio-economic group. By signing this application, I affirm that I endorse this commitment. This application does not create a contract of any type expressed or implied.

Signature*

Date*

Date

Volunteer Registration

Please read carefully and sign below.