Boys & Girls Clubs of the Antelope Valley

Volunteer Application

It is a normal part of the Boys & Girls Clubs of the Antelope Valley procedure to reserve the right to make such checks as we deem appropriate on the suitability of working with children.  This applies to professional and volunteer staff since it is our policy to treat volunteers with all consideration given professionals.  Criminal background checks will be conducted on all applicants in a manner designed not to cause embarrassment but to ensure the safety of our children.  In order for us to do so, please complete the entire volunteer application and attached supplement. 

Name:                                                                        Date:         /      /        
 

Drivers License & State:                                          Date of Birth:          /        /       

Address:                                                                                                           

City:                                               State:                                       Zip:                         

Home Phone:                                                               Work Phone:                                   

Present Occupation:                                                                                                            

Current Employer:                                                                           Supervisor:                                                     

Previous volunteer work or work with youth:

Where                                                     When                                               Contact/Phone                                   

Please list your hobbies:

Please list any social/civic groups you are involved with:

Do you recall how you first heard about the Boys & Girls Club?

References:

Name                                                                 Relationship                                   Phone                                       

 Please List your Boys & Girls Club Volunteer Job Interests:

1.                                                                             

2.                                                                             

3.                                                                              

Please list the times you are available to do volunteer work:

                                                                                        


I declare that all above information is true and accurate to the best of my knowledge.  I understand that all of the above information will be reviewed before I am placed.

Signature:                                                                                         Date:            /         /            


Please do not write below this line-OFFICE USE ONLY
 

Reference Check:                                                                                                                                                             

Background Check:                                                                                                                                                          

Interview By:                                                                                               

Comments:                                                                                                                                                                      

CONSENT

FOR CRIMINAL BACKGROUND HISTORY CHECK AUTHORIZATION/WAVIER/INDEMNITY

I hereby give my permission for the Boys & Girls Club of the Antelope Valley. to obtain information related to any criminal history record. The criminal history record, as received from the reporting agencies, may include juvenile offenses, arrest and conviction data, as well as plea bargains and deferred adjudication.  I understand that this information will be used, in part, to determine my eligibility of an employment or volunteer position with this organization.  I also understand that as long as I remain an employee or volunteer here, the criminal history records check may be repeated at any time.  I understand that I will have an opportunity to review the criminal history and a procedure is available for clarification, if I dispute the record as received.

I, the undersigned, do, for myself, my heirs, executor and administrators, hereby remise, release and forever discharge and agree to indemnify the  Boys & Girls Clubs of the Antelope Valley and each of their officers, directors, employees, and agents harmless from and against any and all causes of actions, suits, liabilities, costs, debts and sums of money, claims and demands whatsoever, and any and all related attorneys’ fees, court costs, and other expenses resulting from the investigation of my background in connection with my application to become a volunteer/staff member.

 

Applicant’s Signature                                                                      Date                                                      

 Name (Typed/Printed)                                                                              Social Security Number                                             

                                                                                      /          /                                                                               

Parent/Guardian Signature                                       Date of Birth               Sex            Race

(if applicant is under 18)

Drivers License Number and State