Volunteer Application

VOLUNTEER APPLICATION

RESUME

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GENERAL INFORMATION

Full Name*

First NameMiddle NameLast Name

List other names you have been known

Date of Birth

Date

Social Security Number

Are you authorize to work lawfully in the United States?*

YesNo

Have you ever been convicted of a felony or misdemeanour?*

YesNo

Gender Assigned at Birth

MaleFemale

Marital Status

SingleMarriedDivorcedWidow

CONTACT INFORMATION

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Mobile Phone Number*

Area CodePhone Number

E-mail*

EMERGENCY CONTACT INFO

Emergency Contact Name*

First NameLast Name

Relationship*

Emergency Contact Phone Number*

Area CodePhone Number

AVAILABILITY

Date Available*

MonthDayYear

Requested Number of hours per week*

Monday

Tuesday

Wednesday

Thursday

Friday

Do you have any disabilities or other circumstances which may interfere with your ability to provide care to children at our childcare center?*

YesNo

If yes, please explain

If you are hired, do you consent to the following: 1) Kaleidoscope Kids may use my photograph , video or other digital media ("Photos") at any time for Kaleidoscope Kids publications including web based or paper, 2) Kaleidoscope Kids may copy, edit, enhance, crop or otherwise alter any Photos for their publications. I waive any rights for approval or inspection of any Photos, 3) I acknowledge that I am not entitled to any compensation or royalties with respect to the use of the Photos.*

YesNo

I understand a TB test is a requirement for volunteer service. I understand I must get a TB test or provide documentation of receiving one in the prior 12 months.*

YesNo

I understand a background check is required for volunteer service. I understand I will be responsible for the cost of the fees through the Indiana State Police for the fingerprinting process*

YesNo

I understand CPR certification may be a requirement for volunteer service. I understand that if I already have a valid/unexpired CPR certification I must provide documentation prior to my first day of volunteer service. If I do not, I understand I may be required to complete this training.*

YesNo

I understand some pre-service or annual trainings may be required for volunteering at Kaleidoscope Kids.*

YesNo

EDUCATION

Highest level of education completed*

If you are a college student, what is your major?

SPECIALIZED EXPERIENCE, VOLUNTEER WORK, TRAINING, SKILLS

Tell us about your character and work ethic. Tell us why you feel Kaleidoscope Kids will be a better place with you working here.