GEM Volunteer Application Form

GEM VOLUNTEER APPLICATION

What a feeling it is to give back!

Volunteering at GEM CULTURE is an EXCELLENT way to give back and contribute to your community. Maybe you're not interested in serving as a GEM Mentor but would like to volunteer in other ways.

Perhaps you have a transportation service and would like to provide transportation or you have a restaurant and would like to provide us with nourishing meals for our sessions.
Or, just maybe you'd like to chaperone and/or support during sessions and events?
Maybe you need community service or intern hours?

If this resonates with you, then this is the perfect fit for you! You don’t need to have a child of your own to get involved—you just need to be passionate about helping others. Your local GEM Village Council can help get you started.

Name of Applicant

First NameMiddle Initial

Last NameMaiden/Former Last Name (write "N/A", if not applicable)

Title/Occupation

Preferred Name

Phone Number

Please enter a valid phone number.Format: (000) 000-0000.

Email

example@example.com

Mailing Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Civil Status

Gender

Date of Birth

Date

Social Security #

Name as it appears on Social Security Card:

Applicant Date of Birth and Social Security Number with Legal Name are required to run background checks. This information will be kept confidential.

Please upload your resume:

REFERENCES

List three (3) persons not related to you who can judge your qualifications for this position. One of whom must be affiliated with GEM CULTURE. They should have known you for at least one year. Names and Phone numbers only.

Name of Reference #1

First NameLast Name

Phone Number of Reference #1

Please enter a valid phone number.Format: (000) 000-0000.

Email of Reference #1

example@example.com

Name of Reference #2

First NameLast Name

Email of Reference #2

example@example.com

Phone Number of Reference #2

Please enter a valid phone number.Format: (000) 000-0000.

Name of Reference #3

First NameLast Name

Email of Reference #3

example@example.com

Phone Number of Reference #3

Please enter a valid phone number.Format: (000) 000-0000.

EMERGENCY CONTACT INFORMATION

Please provide the contact information for at least two (2) individuals closest to you that we can get in touch with in the case of an emergency.

Name of Emergency Contact #1

First NameLast Name

Phone Number of Emergency Contact #1

Mailing Address of Emergency Contact #1

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Name of Emergency Contact #2

First NameLast Name

Phone Number of Emergency Contact #2

Address of Emergency Contact #2

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Please answer all of the following questions as completely as possible.

STATEMENT OF INTEREST: Why do you want to become a GEM Volunteer?

Do you have any previous experience volunteering or working with youth? If so, please specify.

In what ways would you like to volunteer? Please explain.

Have you or anyone in your household been convicted of a crime (other than minor traffic violations)?

If yes, please state offense, date, state and country below (a conviction record will not necessarily be cause for disqualification.):

I verify that there is no registered sex offender residing in my home. insert your initial*

This is an application in GEM Mentoring for which there is no monetary compensation. There shall be no discrimination against an otherwise qualified individual. I understand that a background check will be done using my DOB/SS# (date of birth/social security number). This information will be kept confidential.

I certify that all information provided on this application is true and complete. I understand that falsification or significant omissions of any information may be considered justification for non-acceptance or dismissal if discovered at a later date.

I have read the description for the position for which I am applying. If appointed, I agree to fulfill the position requirements.

Signature

Today's Date

Date

Referred By: