Court Ordered Community Service Form

Thank you for expressing interest in fulfilling your community service hour requirements at Spread the Word Nevada!

You'll need to read and complete this form in full to be considered for placement in our volunteer program. It takes approximately a week to process an application. Applications that are incomplete or contain falsified information will be denied.

We do not accept the following:

Court-appointed community service for any felony or offenses including but not limited to theft, drug possession, assault/battery, larceny, offenses against children, or weapons-related charges.
Any violent offenses including but not limited to assault/battery, domestic violoence, offenses against children, or weapons-related charges.
Walk-ins: All individuals needing to complete court-appointed community service must fill out an application and gain approval before starting any volunteer work. Individuals with court orders who volunteer without approval may be permanently banned from volunteering at STWN.

Note: Completing and submitting this application does not guarantee placement in our volunteer program. Spread the Word Nevada reserves the right to deny any potential volunteer or terminate any existing volunteer for any reason at any time. If accepted, you are responsible for notifying the STWN Volunteer Manager of any forms, letters, signatures or paperwork you need.

Name*

First NameLast Name

Email*

example@example.com

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Phone Number*

Area CodePhone Number

Date of Birth*

Date

Age*

Gender

MaleFemaleNon-binary

Emergency Contact Name*

First NameLast Name

Relationship

Emergency Contact Phone Number*

Area CodeEmergency Contact Phone Number

Emergency Contact Email*

example@example.com

Are you currently working?

YesNo

If yes, where

What is your position?

Name of Supervisor

Work Phone Number

Area CodeWork Phone Number

Background

Spread the Word Nevada may consider the nature, date & circumstances of an offense, as well as whether the offense is relevant to the duties of the position applied for.

Have you ever been convicted of a crime?*

YesNo

Are you currently out on bail, the subject of a current warrant for arrest or released on your own recognizance pending trial?*

YesNo

If yes to either of the above questions, please briefly describe the nature of the crime(s), date and place of conviction and the legal disposition of the case:*

What are you being charged with that requires you to obtain community service hours? List ALL charges. *

How many hours do you need?*

What is your availability to complete the hours?*

Date hours must be completed by:*

Date

Please list the name and contact information of your probation officer / case handler / counselor / referring agency.

Name of Agency*

Case number

Agency Contact Name*

First NameLast Name

Agency Phone Number*

Area CodeAgency Phone Number

Agency Email Address*

example@example.com

If you are under 18 years of age, please provide the name and contact information of your parent or legal guardian.

Guardian Name

First NameLast Name

Relationship

Guardian Email

example@example.com

Guardian Phone Number

Area CodeGuardian Phone Number

Volunteer Agreement & Authorization

I understand the importance of this volunteer commitment and have answered the application
questions honestly and to the best of my knowledge. I understand that falsified information on this
application shall be grounds for immediate dismissal from the volunteer program. I give Spread the
Word Nevada permission to verify the information I have provided in this application. Furthermore, as a
volunteer for Spread the Word Nevada, I – the undersigned – exempt and relieve Spread the Word
Nevada and their directors, trustees, employees and staff from liability for personal injury, property
damage or wrongful death caused by negligence. I understand that Spread the Word Nevada does not
require my participation as a volunteer. I hereby release and discharge Spread the Word Nevada and
their directors, trustees, employees and staff from all claims and liability including those from
negligence arising from my participation as a volunteer. I further agree to hold harmless and indemnify
Spread the Word Nevada and its agents for all defense costs, including attorney’s fees, and any other
costs resulting in connection with my participation as a volunteer for Spread the Word Nevada. I
understand my role as a volunteer at Spread the Word Nevada. I understand to follow their guidelines,
policies and procedures as presented to me in the training. If I do not follow these guidelines, my
volunteer service will end.

Signature*

Clear

Today's Date*

Date

Applicants under the age of 18 years old must have the following section completed by a parent or
legal guardian:

I, Full Name , testify to Spread the Word Nevada that I am the parent/legal guardian of the applicant whose signature appears above. I have read and understood the above Volunteer Agreement & Authorization and hereby give my consent and permission for my child to participate as a volunteer for Spread the Word Nevada. On behalf of the above applicant, I agree and accept all of the provisions of the foregoing Volunteer Agreement & Authorization.

Parent/Guardian Signature

Clear

Today's Date

Date