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  • This form is to be completed, signed and returned to the Painted Brain Community Coordinator at the center or agency at which you are to provide volunteer services unless you are filling this out online. A copy of this completed form will be retained in a file on site. The original will be sent to the Painted Brain Office of Employee & Volunteer Services
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  • Emergency Contact

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  • Education and/or Special Skills

  • Experience with machines or software programs

  • Languages


  • Interests

    Let us know what you're looking to get involved in.

  • Availability

    Let us know what works for you.
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  • VOLUNTEER ACTIVITIES

    Please list all present and former volunteer activities beginning with your present or most recent position first. Use additional pages if needed. Include all other names worked under if different than the name you used on this form.
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  • References

    Two professional references
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  • IMPORTANT – PLEASE READ THIS

    You must complete questions I, II, & III only if the position(s) for which you are applying will involve substantial contact with vulnerable individuals, i.e. elderly, mentally ill, or intellectually challenged, etc.

  • Health Accommodations

  • IMPORTANT – The following must be read and signed by all applicants.

  • I hereby confirm that the information provided in this application is true, correct, and complete. If accepted as avolunteer, any misstatement or omission of fact on this application may result in my dismissal. I hereby authorizePainted Brain Inc., to conduct, obtain, and review state and federal criminal background checks based on the personalidentification information I have provided herein. I hereby grant Painted Brain Inc. permission to check mybackground and references as set forth above. Except in the case of its negligent misuse of the information obtained, Ihereby release Painted Brain Inc., its officers, directors, agents, employees, or representatives from any and all claimsarising from or in connection with my background screening.

    I understand and acknowledge the nature, culture, and environment of mental health communities in which PaintedBrain fosters. I understand and acknowledge that, in accordance with their role as a community wellness center,Painted Brain volunteers must conduct themselves with integrity and act in a manner consistent with the intention ofinclusivity, progressiveness, and the utmost deference for individuals living with mental health challenges, trauma,PTSD, homelessness, formerly incarcerated, formerly fostered, veterans, and at-risk youth.

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    This section is to be completed by Executive Director, Principal or Agency Director only.

    The necessity of passing a state and federal criminal background check for positions involving substantial contact with minors or other vulnerable persons while providing volunteer services has been explained to this applicant. Acceptance of volunteer services is contingent upon the applicant successfully completing the state & federal criminal background check. Signed applications are to be returned to the Painted Brain Community Coordinator at the center or agency for forwarding to the Painted Brain Office of Employee & Volunteer Services.

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