Harmony Home CAC Volunteer Application
Name:
*
First Name
Last Name
Phone Number:
*
Please enter a valid phone number.
Email:
*
example@example.com
Address:
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
If you have less than 3 years at this address, please list a prior address:
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Languages Spoken:
*
Please describe your interest in volunteering with Harmony Home CAC:
*
Do you have any other volunteer experience?:
*
Educational Information
College/University:
Department/Degree
Employment
If currently employed, please complete the following:
Occupation/ Title
Company
Supervisor
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Program of Interest
In the next section, please select your volunteer area of interest. Please note, that if you choose multiple programs, you might be offered interviews for each program as they differ in responsibilities and duties.
Family Greeter
Clerical Support
Special Events Support\
Prevention
Neglect
Availability:
Please note your schedule availability in the table below. Center hours are Monday through Thursday, 8:00 AM to 5:00 PM, and Friday, 8:00 AM to 12:00 PM. Some weekend/after-hours events may be required.
Availability:
Monday Mornings
Monday Afternoons
Tuesday Mornings
Tuesday Afternoons
Wednesday Mornings
Type a question
Wednesday Afternoons
Thursday Mornings
Thursday Afternoons
Friday Mornings
References
Please list two (3) professional or personal references that are NOT related to you.
I authorize Harmony Home CAC to contact my personal references listed and understand that Harmony Home CAC will not be held liable for the release of this information.
*
Yes
No
Reference 1 Name:
First Name
Last Name
Phone Number:
Please enter a valid phone number.
Email
example@example.com
Relationship:
Years Known:
Reference 2 Name:
First Name
Last Name
Phone Number:
Please enter a valid phone number.
Email:
example@example.com
Relationship:
Years Known:
Reference 3 Name:
First Name
Last Name
Phone Number
Please enter a valid phone number.
Email
example@example.com
Relationship:
Years Known:
Further Information
If you have personal experience involving any of the following, please describe
Child Welfare:
Juvenile Court:
Foster Care:
Other agencies offering services to children:
Please list the strength you will bring to the volunteer program:
What are your primary concerns about becoming a Harmony Home Volunteer:
Would you like to share anything else about your personal history? If so, please feel free to write here or verbally at your interview :
Emergency Contact
Name:
First Name
Last Name
Phone Number:
Please enter a valid phone number.
Relationship:
Background Check Release
I grant permission to Harmony Home CAC to initiate, via the Department of Family and Protective Services' online self-service system, a Child Abuse/Neglect Central Registry and a Texas Department of Public Service criminal history check as well as any subsequent checks so long as I am active with the agency. I attest that the information I provide will be correct and that providing false information is a violation of the Texas Penal Code Section 37.10, and I agree to update Harmony Home CAC with any changes to my personal information. I am a prospective intern and consent to release information regarding criminal or abuse history to Harmony Home CAC. I ACKNOWLEDGE THAT I HAVE READ THE ABOVE AND HAVE PROVIDED MY SIGNATURE BELOW.
Signature
Submit
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