G3 Parent/ Volunteer Application Please enable JavaScript in your browser to complete this form.G3 Volunteer Contact Information Name *FirstLastLayoutPhone *Date of birth *SSNEthnicityPlease enter your identified ethnicityGenderMaleFemaleNon BinaryEmail *Address *Address Line 1Address Line 2CityState / Province / RegionPostal Code--- Select country ---AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBolivia (Plurinational State of)Bonaire, Saint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos (Keeling) IslandsColombiaComorosCongoCongo (Democratic Republic of the)Cook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Kingdom of)EthiopiaFalkland Islands (Malvinas)Faroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHondurasHong KongHungaryIcelandIndiaIndonesiaIran (Islamic Republic of)IraqIreland (Republic of)Isle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea (Democratic People's Republic of)Korea (Republic of)KosovoKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesia (Federated States of)Moldova (Republic of)MonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth Macedonia (Republic of)Northern Mariana IslandsNorwayOmanPakistanPalauPalestine (State of)PanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint Martin (French part)Saint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint Maarten (Dutch part)SlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyrian Arab RepublicTaiwan, Republic of ChinaTajikistanTanzania (United Republic of)ThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUgandaUkraineUnited Arab EmiratesUnited Kingdom of Great Britain and Northern IrelandUnited States Minor Outlying IslandsUnited States of AmericaUruguayUzbekistanVanuatuVatican City StateVenezuela (Bolivarian Republic of)VietnamVirgin Islands (British)Virgin Islands (U.S.)Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland IslandsCountryCurrent Employment Information OccupationEmployer NameEmployer AddressAddress Line 1Address Line 2City--- Select state ---AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeProfessional Degree or TitleMDPHDRN or LPNMSNot ApplicablePlease enter your professional title or degrees if applicableSpecial Certification(s)Please enter any special certifications that you have. Ex: CPR, etc..Do you have a valid drivers license?YesNoDrivers License NumberDrivers License StateHave 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 questionAre 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 questionHave you ever been refused participation in any other youth programs? Yes, No If yes, explain: *Please answer yes with explanation or no to this questionEmergency Contact Information Emergency Contact Name *FirstLastLayoutEmergency Contact Phone *Emergency Contact EmailVolunteer Details How did you learn about our volunteer opportunities? Please indicate the person or platform that led you to G3 Life applicationsDo 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?Which days of the week are you available? *MondayTuesdayWednesdayThursdayFridaySaturdaySundayNo PreferenceTBDWhat time of day do you prefer? *MorningAfternoonEveningWhat kind of a time commitment are you able to make? make? (Ex: once, bi-weekly, year, Not sure etc..)What are your areas of interest? *Fundraising/ Corporate SponsorshipAdvocacyTutoringAthleticsCoachingPersonal TrainingDanceMusicTheatre DramaLanguage ArtsMentoringCollege PrepEnvironmentalHealthEducationalFinancialSpecial NeedsRecreationalIndoorOutdoorVirtualPublic RelationsSpecial EventsProgramming AssistancePlease select all that applyDescribe your skills and qualifications:ReferencesPlease list any professional, volunteer or character referencesReference 1 Name *FirstLastReference 1 Phone *Reference 2 Name *FirstLastReference 2 Phone *Reference 3 Name *FirstLastReference 3 Phone *Volunteer Authorizations Background Check *I authorize and consent to a background check conducted by this organizationAS 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 responsibilityApplicant 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. Submit