Parent/Volunteer APPlication – G3 Life Applications, Inc.

G3 Parent/ Volunteer Application

G3 Volunteer Contact Information

Name *

First

Last

Layout

Phone *

Date of birth *

SSN

Ethnicity

Please enter your identified ethnicity

Gender

Email *

Address *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Current Employment Information

Occupation

Employer Name

Employer Address

Address Line 1

Address Line 2

City

State

Zip Code

Professional Degree or Title

Please enter your professional title or degrees if applicable

Special Certification(s)

Please enter any special certifications that you have. Ex: CPR, etc..

Do you have a valid drivers license?

Drivers License Number

Drivers License State

Have you ever been convicted of or plead guilty to any crime(s) involving or against a minor? Yes, No If yes, describe each in full: *

Please answer yes with explanations or no to this question

Are there any criminal charges pending against you regarding any crime(s) involving or against a minor? Yes, No. If yes, describe each in full *

Please answer yes with explanations or no to this question

Have you ever been refused participation in any other youth programs? Yes, No If yes, explain: *

Please answer yes with explanation or no to this question

Emergency Contact Information

Emergency Contact Name *

First

Last

Layout

Emergency Contact Phone *

Emergency Contact Email

Volunteer Details

How did you learn about our volunteer opportunities?

Please indicate the person or platform that led you to G3 Life applications

Do you have any experience working with children or volunteering? If yes, when and where? *

If you speak a language other than English, please list here:

Are there any physical limitations or are you under any course of treatment, which might limit your ability to perform certain types of activities?

What time of day do you prefer? *

Morning
Afternoon
Evening

What kind of a time commitment are you able to make?

make? (Ex: once, bi-weekly, year, Not sure etc..)

Describe your skills and qualifications:

References

Please list any professional, volunteer or character references

Reference 1 Name *

First

Last

Reference 1 Phone *

Reference 2 Name *

First

Last

Reference 2 Phone *

Reference 3 Name *

First

Last

Reference 3 Phone *

Volunteer Authorizations

Background Check *

I authorize and consent to a background check conducted by this organization

AS A CONDITION OF VOLUNTEERING, I give permission for G3 Life Application, Inc. (Hereafter, named G3) to conduct background check(s) on me now and as long as I continue to be active with the organization, which may include a review of sex offender registries, child abuse and criminal history records. I understand that, if appointed, my position is conditional upon G3 receiving no inappropriate information on my background. I hereby release and agree to hold harmless from liability G3, the officers, Board of Directors, employees and volunteers thereof, or any other person or organization that may provide such information. I also understand that, regardless of previous appointments, G3 is not obligated to appoint me to a volunteer position. If appointed, I understand that, prior to the expiration of my term, I am subject to suspension or removal by the G3 Staff any reason including, but not limited to, violation of G3 policies or principles.

Liability Wavier *

I hereby waive this organization of any liability and release them from any responsibility

Applicant Signature *

Clear Signature

Applicants printed Name *

If Minor Parent Signature

Clear Signature

If volunteer is a minor please complete this application with an accompanied parent or guardian signature.