Part-Time Staff Application
All information is held in strict confidence. This form must be filled out in its entirety. The information provided is vital to your acceptance and possible placement as a part-time volunteer.
Sponsored by Royal Family Kids of Northeast Iowa
PO Box 314 Sumner, IA 50674
June 14-19 • 2026
Your Name
*
First Name
Last Name
Sex
*
Please Select
Male
Female
Driver's License or SSN
*
Birthdate
*
-
Month
-
Day
Year
Date
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Email
*
example@example.com
Phone Number
*
Format: (000) 000-0000.
Marital Status
*
Occupation
*
Emergency Contacts
*
T-Shirt Size
*
Please Select
Adult X-Small
Adult Small
Adult Medium
Adult Large
Adult X-Large
Adult XX-Large
Adult XXX-Large
Do you have previous training, background, or experience working with abused, neglected, or abandoned children? (Please Explain)
*
Please describe why you wish to be a volunteer for RFK?
*
Which part-time volunteer position(s) are you interested in? Please note that indicating interest does not guarantee placement in that role, as availability may vary.
Registration
Birthday Party
Carnival
Other
Criminal Background
If your records have been expunged pursuant to applicable law, you are not required to answer yes to the following questions. If you are unsure whether to answer yes, we strongly suggest that you answer yes and fully disclose all incidents to avoid any future risk of embarrassment upon disclosure.
1. Have you ever been convicted of or pleaded guilty to any crimes including municipal, state and federal?
*
Please Select
Yes
No
2. Have you ever been placed on probation, received a Suspended Execution, Suspended Sentence or Suspended Imposition of Sentence for any offense involving a minor child (a child under 18), or been placed on ANY local, state, or federal sexual registry?
*
Please Select
Yes
No
3. Have you ever been sued in a civil court of law where the allegations in the suit involved illegal, inappropriate, or sexual conduct or contact with a minor child?
*
Please Select
Yes
No
4. Have you ever been subject to any court order involving any sexual, physical or verbal abuse including but not limited to any domestic violence or civil harassment injunction or protective order?
*
Please Select
Yes
No
5. Have you ever resigned, been terminated or been asked to resign from a position, whether paid or as a volunteer, due to a complaint(s) of sexual, physical or verbal abuse of minors?
*
Please Select
Yes
No
If you answered yes to any of the above questions, please describe:
Representations and Release
The information contained in this application is correct to the best of my knowledge. I sign this document as my own free act. This is a legally binding agreement which I have read and understand. I acknowledge that submitting this application is only the first step in the volunteer process and that acceptance is not guaranteed. Please be advised that a criminal history check may be requested from the state of Iowa as authorized by state law.
Signature
*
Continue
Should be Empty: