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SALLY KATE WINTERS FAMILY SERVICES

VOLUNTEER/TUTOR/INTERN

APPLICATION

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Position applied for:          Volunteer          Tutor       Intern         Date: ________________

 

 

            Name: ________________________________________________________________

                        Last                                                     First                                        Middle

 

            ID # or Drivers License #: _______________Are you 18 years old or older?    Yes     No 

           

            Home Telephone: __________________________  Cell: ________________________

 

            Email: ________________________________________________________________

           

            Address: ______________________________________________________________

 

            ______________________________________________________________________

 

            Address to send correspondence: __________________________________________

 

            ______________________________________________________________________

 

            Educational Background (TUTORS: must have at least 20 hrs of college credit): ___

 

            ______________________________________________________________________

 

            Previous and/or current volunteer experience: _________________________________

 

            ______________________________________________________________________

 

            How did you learn about the SKW program? __________________________________

 

            ______________________________________________________________________

 

            Do you have any special areas in which you were interested in volunteering (such as

            tutoring, parties, recreational, office, etc…)? ___________________________________

 

            ______________________________________________________________________

 

            Times Available:

 

            Weekdays:    M         T          W        Th       F          Hours Available:____________________

 

            Weekends:    Sat.     Sun.                                       Hours Available: ___________________

 

            Holidays: _______________________________________________________________

 

           

            Are you aware that you will have to complete a background check and fingerprinting        

            prior to volunteering? ______  ($20 cash payment is required in advance to cover costs.)

           

            Are you aware that you will have to complete a volunteer orientation? ______________

 

            Will you be willing to participate in ongoing training and activities? _________________

 

            What are the strengths that you will bring to this program? _______________________

 

            ______________________________________________________________________

 

            Have you had personal experience involving?

            __________ Child Welfare                                                __________ Juvenile Court

            __________ Foster Care                                        __________ Other Child Services

 

            If so, explain: ___________________________________________________________

 

            ______________________________________________________________________

 

            Write a brief statement as to why you have chosen to volunteer at the SKWFS:             ______________________________________________________________________

 

            ______________________________________________________________________

 

            What additional information would you like about the SKW Family Services? _________

 

            ______________________________________________________________________

 

            Please provide four (4) references, including their addresses and phone numbers:

 

            1.____________________________________________________________________

 

            ______________________________________________________________________

 

            2.____________________________________________________________________

 

            ______________________________________________________________________

 

            3.____________________________________________________________________

 

            ______________________________________________________________________

 

            4.____________________________________________________________________

 

            ______________________________________________________________________

 

           

            My signature verifies that this information is accurate to the best of my knowledge.

 

            __________________________________________________        ________________

            Signature                                                                                                      Date

 

 

 

 

 

 

 

 

PERMISSION FOR BACKGROUND CHECK

 

 

I give my permission for the Sally Kate Winters Family Services to conduct a screening with law enforcement, the Child Abuse Central Registry, previous employees and any other persons to determine my suitability in working with children.  I understand that this permission is part of my application to work/volunteer at the Sally Kate Winters Family Services.

 

 

Name                                     _____________________________________________________

 

Current Address       _____________________________________________________

 

                                    _____________________________________________________

 

Permanent Address _____________________________________________________

 

                                    _____________________________________________________

 

Current Telephone _____________________________________________________

 

Date of Birth              _____________________________________________________

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

__________________________________________________        ________________

            Signature                                                                                                      Date