Community Service Application
You will be contacted within 48 hours of submitting this form. IF you have any questions or concerns, please contact Madi Barnhardt at mbarnhardt@neifb.org.
Any Recent or Past Convictions Involving the Following will NOT be Allowed to Complete Community Service Hours at the NEIFB:
Assault/Aggravated Assault, Battery, Kidnapping/Child Endangerment, Harassment, Domestic Violence, Sexual Abuse/Assault/Rape, Murder.
Full Name
First Name
Last Name
Date of Birth
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Month
-
Day
Year
Date
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
When is the Best Time to Call?
E-mail
example@example.com
Emergency Contact Name
First Name
Last Name
Relation to Emergency Contact
Emergency Contact Phone Number
Please enter a valid phone number.
What are you doing hours for?
Facility
Adult Court
Juvenille Court
Number of Hours to Complete
By What Date do the Hours Need to be Completed by?
-
Month
-
Day
Year
Date
Probation Officer's Name
First Name
Last Name
Probation Officer's Phone Number
Please enter a valid phone number.
Probation Officer's Email
example@example.com
In What State and County are your Charges in?
Any Special Needs you would like us to Know About? (i.e. medical issues, allergies, etc.)
Are There Any Facts or Circumstances in your Background that would Prevent you from being Entrusted with Children? If so, Please Explain.
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Background Check
The Northeast Iowa Food Bank conducts background checks on volunteers completing community service hours to ensure a safe and productive volunteer environment. It is our policy to conduct background checks on all volunteers who are here to earn community service hours. By signing this electronic form, you give the Northeast Iowa Food Bank use of any information provided during the application process to perform a background check. Any information obtained in the background check is kept confidential and only viewed by those reviewing the application. Applicants will be disqualified if the background check report contains any of the following convictions or offenses, including but not limited to: assault/aggravated assault, battery, kidnapping, sexual abuse/assault, child endangerment, domestic violence, rape, murder, harassment. By signing this electronic form, I hereby authorize the Northeast Iowa Food Bank to conduct a background check.
Name
First Name
Last Name
Signature
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