Volunteer Application

Availability:

Monday: to

Tuesday: to

Wednesday: to

Thursday: to

Friday: to

Saturday: to

History

Years of School Completed:

Previous Occupations:

Physical Condition:
ExcellentGoodFairPoor

Interests

In which areas are you best suited to volunteer?
Academic TutoringPhysical Fitness, HealthJob ReadinessFundraisersPublic RelationsCommunity DinnerPerforming ArtsCreative DanceSpecial EventsVolunteer Leadership

Explain why you want to be a volunteer.

Special skills or qualifications.

Skills and qualifications can be acquired through employment, previous volunteer work, or other
activities such as hobbies or sports. What skills or qualifications do you have as a volunteer?

Previous Volunteer Experience

Have you worked as a volunteer before? If so, what did you do?

Certifications

Are you certified in:
First AidPhysical FitnessNutritionOther

Transportation

Do you have your own means of transportation?YesNo

Memberships in Clubs and Organizations

List clubs and organizations of which you are a current member.

Contact in case of Emergency








Criminal Background History

Do you have any criminal convictions (other than parking violations and juvenile offenses)?
YesNo
If yes, please describe:

Please list two character references (not relatives)

1:

2:

IAMBK Policy

It is the policy of the organization to provide equal opportunities without regard to race, color,
religion, national origin, gender, sexual preference, age, or disability.

We make an active effort to prevent child abuse, which may include but is not limited to a
background check and references from past employers and volunteer organizations.

When practical, volunteers should not put themselves in a position in which they are alone with a
single child and cannot be observed by others. Allegations or suspicions of child abuse are taken
seriously and are reported to police and/or state agencies for investigation.

IAMBK goals for children are:

1. To help children develop to their fullest potential
2. To deliver programs in a positive environment of safety, support, and care
3. To support and strengthen the family unit

Affirmation and Signature

By submitting this application, I affirm that the facts set forth in it are true and complete. I
understand that if I am accepted as a volunteer, any false statements, omissions, or other
misrepresentations made by me on this application may result in my immediate dismissal. I further
understand that my service is subject to government regulations, IAMBK’s review and acceptance of
fingerprint record and proof of minimum age.

I have been informed of IAMBK’s position regarding child abuse, and have read and understand
that portion of my Volunteer Application. I understand that in addition to the state mandates,
IAMBK will, among other things, conduct a criminal background check. I understand that
allegations or suspicions of child abuse are taken very seriously by IAMBK and will be reported to
police and/or state agencies for investigation. IAMBK will fully cooperate with any related
investigations and will pursue the prosecution of child abusers to its full extent screening. I hereby waive any right to claim that any request or investigation is an invasion of my privacy, since they are made with my consent and it is in my best interest while being considered for a volunteer position, and still desire consideration as a volunteer for IAMBK.

Thank you for completing this application form and for your interest in volunteering with us.