Valley Haven Volunteer Application

Volunteer Application
Full Name*

FIRST NAMEMIDDLE NAMELAST NAME
Previous Names (if applicable)*

OTHER FIRST NAMESOTHER MIDDLE NAMESOTHER LAST NAMES
Address*

STREET ADDRESS

Street Address Line 2

CITYSTATE

ZIP CODE
COUNTY*
CONTACT NUMBER*
EMAIL*
example@example.com
DATE OF BIRTH*

MonthDayYear
Date
SOCIAL SECURITY #*
DRIVERS LICENSE #*
Gender*

MaleFemale
Ethnicity*

HispanicNon-Hispanic
Race*

WhiteBlackAsianAmerican IndianNative HawaiianOther
Why would you like to volunteer at Valley Haven?*
What are you interested in doing while volunteering at Valley Haven?*
PROPOSED DAYS & TIMES YOU ARE AVAILABLE
SKILLS/CERTIFICATIONS
AUTHORIZATION FOR BACKGROUND CHECK
I First & Last Name* , hereby authorize VALLEY HAVEN INC. to investigate my background and qualifications for purposes of evaluating whether I am qualified for the position for which I am applying. I understand that VALLEY HAVEN INC. will utilize an outside firm or firms to assist it in checking such information, and I specifically authorize such an investigation by information services and outside entities of the company's choice. I also understand that I may withhold my permission and that in such a case, no investigation will be done, and my application for volunteering will not be processed further.
Volunteer Signature*

Clear
Date*

MonthDayYear
Date
I understand that I must immediately report any suspected incident of abuse, neglect, or exploitation to the Texas Abuse and Neglect Hotline at 1-800-252-5400 and Valley Haven's Executive Director or Program Director immediately.

I understand that photos are NOT to be taken of children.

PLEASE INITIAL BELOW
Volunteer Initials*

Clear
Date*

MonthDayYear
Date
Please contact Kristen Millon, Executive Director, with any questions at KristenMillon@valleyhaveninc.org or 361-548-9614.
Should be Empty:

Volunteer Application

AUTHORIZATION FOR BACKGROUND CHECK