Volunteer Application

Volunteer Application
Thank you for your interest in our organization!

We are deeply committed to making a meaningful impact in the lives of the young people we serve. That’s why we seek volunteers who are trustworthy, dependable, patient, and genuinely called to the ministry of serving children and youth.

Please note that all applicants are required to complete a background check before being accepted into our program.
Name*

First NameLast Name
Date of Birth*

MonthDayYear
Date
Gender*

MaleFemale
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*
E-mail*
example@example.com
How did you hear about this volunteer opportunity?
What is your highest completed level of education?*

Some high school coursework completedHigh school diploma or equivalentAssociate's degreeSome college coursework completedBachelor's degreeMaster's degreeDoctorate's degree
Do you have a valid driver's license?*

YesNo
Are you willing to submit a background check?*

YesNo
Which role are you interested in serving?*
What experience or qualifications make you a strong fit for this role?*
What strengths or skills would you contribute to our program?*
Why are you interested in volunteering with us? What motivates you to serve in this capacity?*
Please describe your availability:*
Please supply three character references:

(A minimum of two references must be non-related)
Reference #1
Name*

First NameLast Name
Relationship*
Phone Number*
Please enter a valid phone number.
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Reference #2
Name*

First NameLast Name
Relationship*
Phone Number*
Please enter a valid phone number.
Address

Street Address

Street Address Line 2

CityState

Zip CodeCountry
Reference #3
Name*

First NameLast Name
Relationship*
Phone Number*
Please enter a valid phone number.
Address

Street Address

Street Address Line 2

CityState

Zip CodeCountry
Have you at anytime ever:
Been convicted of or pleaded guilty or no contest to any crime?*

YesNo
Please explain:*
Participated in or been accused, convicted, or pleaded guilty or no contest to abuse or any sexual misconduct?*

YesNo
Please explain:*
Had a restraining order filed against you?*

YesNo
Please explain:*
Are you aware of:
Having any traits or tendencies that could pose any threats to children, teens or others?*

YesNo
Please explain:*
Any reason why you should not work with children, teens or others?*

YesNo
Please explain:*
Do you use illegal drugs or substances?*

YesNo
Please explain:*
Do you currently smoke or vape?*

YesNo
Please explain:
I understand that Urban City Impact is relying on the accuracy of the information I provide in this application. I authorize the organization to contact any individuals or entities listed, and I give those individuals or entities permission to share information, opinions, and impressions regarding my background and qualifications. I voluntarily release both Urban City Impact and those contacted from any liability related to the exchange of this information. I certify that the information I have provided in and with this application is true and correct to the best of my knowledge.
Signature*

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