Wyandot Community Connections Application for Volunteer Service

Name*

First NameLast Name

Email

example@example.com

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Cell Phone Number*

Please enter a valid phone number.

Home Phone Number

Please enter a valid phone number.

Preferred Form of Contact*

Cell PhoneHome PhoneTextE-mail

Date of Birth*

Date

Emergency Contact (please list a name, their relationship to you, and a phone number)*

What HUB volunteer areas are you interested in?

FundraisingProgramsMaintainenceOther

What HUB Kids (after-school program) volunteer areas are you interested in?

ActivitiesPresentationsHomework HelpOther

What days and times are you available? The HUB volunteer times are Monday - Friday from 2:45–5:30 pm or a minimum of 1 hour within that time frame.*

How often are you available to volunteer?*

WeeklyBi-weeklyMonthlyOther

What is your interest in The HUB and why are you interested in volunteering?*

Please list any experiences you have had working with children and teens.*

Please summarize any special skills and qualifications you have acquired from employment, previous volunteer work, life experience, or other activities.*

Background Check

Please provide an electronic or hard copy of your current (within 3 years) background check or obtain a new one.

One location available to obtain a background check is Trinity Evangelical church.

References

Please list 2 References - Personal and Work-Related (no relatives please) Name/Relationship/Phone*

Disciplinary and Legal Background of Applicant

Have you ever been charged with a sexual offense or crime of violence?*

YesNo

Have you ever been convicted of a criminal offense (felony or misdemeanor, except for minor trafficviolations)? You will need to answer "yes" if you have entered into a plea agreement, including adeferred sentence or deferred judgment arrangement, in connection with a criminal charge.*

YesNo

Have you ever been reported to a social services agency, law enforcement authority, child abuse registry, or similar organization regarding abuse or misconduct?*

YesNo

Have you ever been the subject of a civil lawsuit involving sexual misconduct, sexual harassment, or other immoral behavior or conduct?*

YesNo

Have you ever been the subject of a complaint or disciplinary proceeding against a professional license for another license held by you?*

YesNo

Have you ever been subject to any disciplinary action (including discharge) or investigation by a religious organization, or employer?*

YesNo

Agreement

I give permission and consent to The HUB/Wyandot Community Connections and third parties collaborating with HUB/WCC to make, reproduce, edit, broadcast, or rebroadcast any photo, video, soundtrack recording of me while participating in HUB/WCC activities and/or programs, and including any written or spoken narrative account of experiences at The HUB for publication, display, or exhibition in promotions, advertising, and legitimate business uses by and for HUB/WCC. I further understand there will be no compensation to, and/or claim, by me or my child for such items.*

YesNo

I affirm that all the answers and information I have provided on this application form are true and complete to the best of my knowledge. I authorize The HUB/Wyandot Community Connections to conduct an investigation concerning my background for suitability for volunteering. I authorize The HUB/Wyandot Community Connections to contact all references identified by me.*

Thank you for your offer to volunteer to help strengthen families
and youth in our community!

The HUB/Wyandot Community Connections is committed to building a strong and safe community by providing a facility for arts, education, recreation and locally based services to increase opportunities for personal and collective growth.

The HUB Kids youth program provides a welcoming, safe, and structured environment for local youth to spend time with friends, receive homework help, play games, participate in workshops such as healthy cooking, fitness, art forms, car maintenance, and develop social and life skills.

Our goal is to let our local youth know they are valued, cared for, appreciated, and respected!

The information provided on this form will be kept confidential and will help us determine the most satisfying and appropriate volunteer opportunity for you.