ELC Volunteer Registration Form

Assistants assist clients and center staff and are available to work with clients as directed by primary staff / Client Advocates (CAs). Assistants provide support to clients, center staff and Instructors, are available during client interactions and maintain compliance with the center’s policies. Assistants may offer homework help as needed if they are familiar with the given topic, offer reassurance as needed; up to and including being present during mediation, and may include temporarily covering the overseeing of the general center if/when a CA is unavailable and or involved in mediation. Assistants may be called on as needed to assist in mediating disruptions as directed by a CA.

Assistant hours are 2:45pm-6:15pm.

Full Name*

First NameLast Name

Please select your current age range*

Over 18 under 21Over 21 under 35Over 35

E-mail*

example@example.com

Phone Number*

Can this number receive texts?*

YesNo

What days would you be available?*

TuesdaysWednesdaysThursdays

Have you worked with youth, high school age or young adults in the past?*

YesNo

What was the name of the organization   Type a label
How long did you work or volunteer there   Type a label
Why did you leave   Type a label.

May we contact them for a reference?*

YesNo

If yes, please provide contact information: name, title, and phone number of reference

If no, please explain

Have you ever been let go, fired or asked to leave a position, working with children, youth, elderly or other vulnerable persons/ populations?*

YesNo

If yes, please explain. Include dates and details of dismissal

Have you ever had an accusation of inappropriate or violent conduct made against you*

YesNo

If yes, explain. Include date, details and outcome of accusation. i.e. were criminal or civil charges filed or was the accusation dismissed

Please list a non family member reference*

First and Last nameRelation

Reference phone number*

Please enter a valid phone number.

Years known*

Have you ever had any non motor vehicle arrest or convictions*

YesNo

if yes list offense and year of conviction / arrest

Do you have any current or pending criminal charges. Are you currently on probation*

YesNo

if yes list offense and year of conviction / arrest

if on probation list name and contact number of probation officer

Have you ever been instructed not to have contact with children or do you have a history of sex offender registration?*

NoYes

To the best of my knowledge the above information is true and accurate. *

Any Special Comments or questions about the position

Staff Application - Assistant