Volunteer Application

Volunteer Application

Our mission is to enable all young people, especially those who need us most, to reach their full potential as productive, caring, responsible citizens. Our programs focus on helping kids succeed in school, live healthier, and become leaders. The Boys & Girls Clubs of Rutherford County appreciates the help we get from volunteers in our community. Each volunteer can assist the staff in providing quality programs and services to the young people in our area. To ensure that we have an excellent volunteer program at the Club, we ask that each volunteer read and sign the information on this application annually.
Club Location*

MurfreesboroShelbyvilleSmyrna
Name*

First NameMiddle NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Primary Phone Number*
E-mail*
Date of Birth*

MonthDayYear
Emergency Contact*

First NameLast Name
Phone Number*
Professional/Civic/Social Affiliations
Are you volunteering as part of a group event?*
If No, put N/A
PURPOSE OF VOLUNTEERING

Fill out areas that apply.
Student Volunteering or Student Internship
Please attach any required documents.
Corporation Volunteer
Other
Tennessee Promise, etc.
Additional Documents

Browse Files

Cancelof
AVAILABILITY

We have many volunteer opportunities within our Clubs that can be customized to your schedule. Clubs are typically open between 2:30-7:00 p.m. on weekdays only.
Monday
Ex: 3:00pm-5:30pm
Tuesday
Wednesday
Thursday
Friday
INTERESTS
Please indicate area(s) in which you are interested in

AcademicsSports & RecreationArts & Crafts, MusicMentoring *May require additional background screeningOther
Age Group Preference

Kindergarten- 1st Grade2nd and 3rd Grade4th and 5th Grade6th and 7th GradeTeens
BACKGROUND CHECK INFORMATION
Social Security Number*
Have you ever been convicted of a felony or misdemeanor?

YesNo
If "Yes", explain
Have you ever volunteered or worked at a Boys & Girls Club?

YesNo
If "Yes", explain
Have you ever worked with children/youth through employment or as a volunteer?

YesNo
If "Yes", explain
Other Volunteer experiences
The Boys & Girls Club does not carry accident or medical insurance on any volunteers or program activities.

I certify that all the answers on the application and any attachments are true and complete to the best of my knowledge. I also certify that I have not withheld any pertinent information.

I agree that in the considering of my application, you may inquire to verify information concerning my background. I specifically authorize you to investigate all statements in this application. I authorize educational institutions, employers and references listed above to give you all information concerning my education, employment, and fitness to work with children and young people. I further agree to release and hold harmless the Boys & Girls Clubs of Rutherford County, Inc., institutions, and references listed above and any law enforcement agency, from all liability and any damage that may result from furnishing this information to you.
By clicking this checkbox, I understand that this box constitutes as a legal signature, confirming that I acknowledge and agree to the terms listed above*
E-Signature

First NameLast Name
Today's Date

MonthDayYear
CRIMINAL HISTORY BACKGROUND CHECK DISCLOSURE AND AUTHORIZATION

The Boys & Girls Clubs of Rutherford County (BGCRC) is committed to the protection of all persons who are associated with BGCRC including Club members, staff, all volunteers and board members. In order to perform our due diligence, BGCRC shall conduct criminal background checks of all employees and volunteers whose commitment will last more than one day or will work directly with Club members.

As part of the criminal background check, BGCRC will procure a consumer report in connection with employment or volunteer service. TBI, First Advantage or another consumer reporting agency will prepare the report, which will include but not limited to; verification of the individual’s identity and legal aliases, a national search of criminal records and a national search of sex offender registries. BGCRC may rely on this authorization to obtain background check reports throughout employment or volunteer services.

In the event that information from the report is utilized in whole or in part in making an adverse decision with regard to employment or volunteer service, before making an adverse decision, applicant will be provided with a copy of the consumer report and a summary of rights under the Fair Credit Reporting Act. BGCRC will carry out this requirement in a fair, consistent and non-discriminatory manner, complying with applicable state and federal laws and guidelines, including the Fair Credit Reporting Act and the Equal Opportunities Commission.
I have carefully read and understand the Disclosure and Authorization form and authorize BGCRC to conduct a criminal background check in connection with my employment or volunteer service.*
Should be Empty:

Volunteer Application

PURPOSE OF VOLUNTEERING

AVAILABILITY

INTERESTS

BACKGROUND CHECK INFORMATION