Volunteer Application 2023 final

Personal Information
Name*
Today's Date*

MonthDayYear
Date
Address*

Street Address

Street Address Line 2

City, State, ZipState / Province

Postal / Zip Code
Home Phone
Cell Phone*
E Mail*
example@example.com
Referred by
Emergency Contact*
Emergency Contact #*
Date of Birth*

MonthDayYear
Date
Social Security Number*
Background Information
What's your level of education?*
What's your college major, if applicable? *
What's the name of the last school you attended?
Do you have a felony conviction? Enter yes or no. If yes, describe. A previous conviction does not necessarily disqualify you from consideration.*
Who is your current employer and what is your position? *
Please upload your resume.

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Volunteer Info
What is your previous volunteer history (when, where, roles, etc.)?*
How did you hear about LLC and why do you want to volunteer here? *
Is there anything else you want us to know?*
Skills Profile

Check any of the skills you feel you have to offer and please include a short description.*

	Yes or No	Comments
Teaching (Curriculum prep & delivery)
Coaching (Listening, feedback, mentoring, etc.)
Recovery/Peer Support
Reentry (experience in Judicial system)
Job/Career (Resumes, Interviews, etc.)
Financial (Budgeting, banking, etc.)
Leadership (Organizational, planning, consulting, etc.)
Spiritual (Love, forgiveness, etc.)
Writing (Social media, content, etc.)
Administrative (Reception, answering phone, etc.)
Technology (Computers, Microsoft Windows, etc.)
Food prep (Cooking, meal planning, etc.)
Development (Fundraising, PR, etc.)
Other

THE ABOVE INFORMATION IS ACCURATE AND CORRECT TO THE BEST OF MY KNOWLEDGE. I UNDERSTAND THAT IF I USE MY PERSONAL AUTOMOBILE IN MY VOLUNTEER SERVICE, I WILL ARRANGE TO KEEP IN EFFECT AUTOMOBILE LIABILITY INSURANCE EQUAL TO THE MINIMUM REQUIRED BY THE STATE OF KENTUCKY. MY SIGNATURE BELOW INDICATES I HAVE READ THIS STATEMENT AND OFFER MY APPROVAL FOR LIFE LEARNING CENTER TO CHECK MY PERSONAL REFERENCES AND CONDUCT A CRIMINAL RECORDS CHECK IF REQUIRED FOR THIS VOLUNTEER ACTIVITY. I ALSO UNDERSTAND THAT LIFE LEARNING CENTER IS NOT OBLIGATED TO PROVIDE A VOLUNTEER PLACEMENT FOR ME, NOR AM I OBLIGATED TO ACCEPT A PLACEMENT. I UNDERSTAND THAT LIFE LEARNING CENTER OFFERS VOLUNTEER OPPORTUNITIES WITHOUT REGARD TO RELIGION, RACE, NATIONAL ORIGIN, CREED, AGE, OR SEX.*

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MonthDayYear
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Declaration of Volunteer Participation and Release of Liability
I, First Name* Last Name* , am not an employee of the Life Learning Center. I have volunteered to participate in Type a label* (Activity). By this declaration, I acknowledge that my participation in the activity is entirely voluntary. I understand that my participation in the activity is not intended to nor does it create any special legal relationship between Life Learning Center and me and that neither Life Learning Center nor any of its employees has required me to participate in this activity.
I acknowledge that Life Learning Center does not have any liability for payment of workers’ compensation benefits to me for any injury, damage or death that results from my negligent behavior, which may arise out of my participation in the activity. With knowledge that there may be risks involved, I voluntarily consent to participate in the activity and agree to assume any and all risks of injury, damage or death from my participation.

I, hereby agree that I, my heirs, distributes, guardians, legal representatives and assignees shall not make a claim against, sue, attach the property of, or prosecute Life Learning Center, Life Learning Center’s Board of Directors and each member thereof, or Life Learning Center’s agents, employee or representatives. I hereby release and discharge Life Learning Center, Life Learning Center’s Board of Directors and each member thereof, its agents, employees, or representatives for all actions, claims, or demands the I, my heirs, distributes, guardians, legal representatives or assignees may have or may hereafter have from injury, damage or death resulting from my participation in the activity.

I HAVE CLEARLY READ THIS DECLARATION OF VOLUNTARY PARTICIPATION AND RELEASE OF LIABILITY AND FULLY UNDERSTAND ITS CONTENTS. I AM AWARE THAT BY SIGNING THIS RELEASE OF LIABILITY, I WILL BE GIVING UP ANY ABILITY TO MAKE A CLAIM OR SUE LIFE LEARNING CENTER, ITS BOARD OF DIRECTORS, AGENTS, EMPLOYEES OR REPRESENTATIVES FOR ANY INJURY, DAMAGE OR DEATH RESULTING FROM MY OWN NEGLIGENCE. WITH THIS IN MIND AND WITHOUT ANY MENTAL RESERVATION, I SIGN THIS RELEASE OF LIABILITY VOLUNTARILY.
Signature*

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Volunteer Statement of Confidentiality
Life Learning Center’s mission is to help “at-risk” citizens to step up to their highest potential by delivering a holistic integrated continuum of education and care. As a result of the services we provide for individuals and families as Candidates, Members, and Recovery Community Center guests, we have access to information of an extremely personal nature. It is important that all information that you may come across as a volunteer for Life Learning Center be kept in the strictest of confidence.

By signing below, you acknowledge the need to maintain confidently of all issues concerning the clients and services of Life Learning Center and agree to uphold the utmost confidentially during and after your time with us.

I understand, agree with and adhere to the above.
Signature*

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Date

Photo & Media Release
Select one of the following regarding use of photo and media:*

I do grant permission for my picture to be taken, which may be used in news releases, agency brochures, posters, or presentations for publicity for Life Learning Center. I understand my photo may also be taken and distributed to the news media to be used in conjunction with a story about Life Leaning Center. I understand I will receive no compensation and hold the agency harmless. I understand that if, at any time, which I voluntarily speak to any media concerning Life Learning Center, and the services that I receive or perform, that it is confidential in nature and I should not disclose personal and/or confidential information. I also understand that I discharge Life Learning Center from liability in the event that I voluntarily or inadvertently disclose confidential information about myself or others.I do NOT grant permission for my picture to be taken or used in news releases, agency brochures, posters, or presentations for publicity for Life Learning Center. I understand this is purely voluntary.
Signature*

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Personal Information

Background Information

Volunteer Info

Skills Profile

Declaration of Volunteer Participation and Release of Liability

Volunteer Statement of Confidentiality

Photo & Media Release