YMCA of the Twin Tiers Volunteer Application

Volunteer Application

Please complete the form below to be considered for volunteer work at the YMCA of the Twin Tiers!
Full Name

First NameMiddle NameLast Name
Any former names or aliases:

First NameLast Name
Current Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email Address
example@example.com
Phone Number

Area CodePhone Number
Are you 18 years of age or older?
If under age 18, state your age:

Have you ever been convicted of a felony, or for child abuse or sex-related crimes?*?
If yes, please give details:
Are you currently listed on any state sex offender registry levels 1, 2, or 3?
Have you ever been investigated for abuse, misconduct, or boundary violations?
If yes, please explain:

Why do you want to volunteer for the YMCA?
Please list any previous volunteer experience (please note any experience working with children or vulnerable populations):
Are there any special considerations or restrictions on your volunteering? Please type yes or no. If yes, explain.

REFERENCES: List the names of three references, 18 years or older, whom you have known at least one year.

Employment:

Are you retired?
Have you ever been terminated or asked to resign from a position involving children or vulnerable persons?
If yes, please explain:

Education:

Rows	School Name	School Address	Years Attended	Subjects studied or degree(s) obtained
High School
College
Trade/Business School

In order to be considered for volunteer opportunites with the YMCA of the Twin Tiers, you must read and agree to follow the follow policy. Click below to access the document:

YMCA of the Twin Tiers Child Abuse Prevention Policy and Code of Conduct
Signature: My signature confirms my acknowledgment and agreement to comply with these requirements. I understand that signing this form does not replace my responsibility to know and follow the Child Abuse Prevention Policy, Code of Conduct, applicable YMCA procedures, and applicable mandatory reporting laws..

Signature: I hereby acknowledge that I have read and understood the above statements, and that I voluntarily sign this application.
Today's date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Should be Empty: