SOOK Volunteer Application

Additional Information
Occupation (Owner, Teacher, Student, etc.)*
Employer or School Attending*
Gender *
Race/Ethnicity (optional)
Race/Ethnicity Other
Emergency Contact Name (Not Self)*
Emergency Contact Phone # (Include Area Code)*

Personal History

Answering yes does not necessarily preclude you from volunteering. Your application will go through a screening process to determine your eligibility. You will be notified if information affects your eligibility as a SOOK volunteer.
Do you use illegal drugs?*

YesNo
Have you ever been convicted of a criminal offense?*

YesNo
Date of occurrence*

MonthDayYear
Date
State of occurance*
Explain*
Have you ever been charged with neglect, abuse, or assault?*

YesNo
Date of occurrence*

MonthDayYear
Date
State of occurrence*
Explain*
Has your driver's license been suspended or revoked in any state or jurisdiction?*

YesNo
Date of occurrence*

MonthDayYear
Date
State of occurrence*
Explain*
List two NON-FAMILY References
1) Full Name*
1) Relationship*
1) Phone #*
2) Full Name*
2) Relationship*
2) Phone #*

Read Carefully Before Submitting
I understand that:
• The information that I have provided may be verified, and I give permission to Special Olympics to make inquiry of others concerning my suitability to act as a Special Olympics volunteer, and I release from liability any person giving or receiving such information (SOOK is required to complete background screenings for all Class A Vols);

• In the course of volunteering for Special Olympics, I may be dealing with confidential information and I agree to keep said information in the strictest confidence;

• The relationship between Special Olympics and the volunteer is an ‘at will’ arrangement, and that it may be terminated at any time without cause by either the volunteer or Special Olympics.

• I grant Special Olympics permission to use my likeness, voice, and words in television, radio, film, or in any form to promote activities of Special Olympics.
Confirm*

Yes
Confirm/Signature Date*

MonthDayYear
Date
Signature*

Clear
APPLICATION VALID FOR 3 YEARS FROM DATE SIGNED!
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