Your SlideShare is downloading. ×
Bully  Prevention  Alliance  Volunteer  Application
Bully  Prevention  Alliance  Volunteer  Application
Bully  Prevention  Alliance  Volunteer  Application
Bully  Prevention  Alliance  Volunteer  Application
Bully  Prevention  Alliance  Volunteer  Application
Upcoming SlideShare
Loading in...5
×

Thanks for flagging this SlideShare!

Oops! An error has occurred.

×
Saving this for later? Get the SlideShare app to save on your phone or tablet. Read anywhere, anytime – even offline.
Text the download link to your phone
Standard text messaging rates apply

Bully Prevention Alliance Volunteer Application

230

Published on

Interested in becoming a volunteer for Bully Prevention Alliance and you live in the state of Indiana? Please fill out the volunteer application and submit it to: Info@bpindyinc.org. …

Interested in becoming a volunteer for Bully Prevention Alliance and you live in the state of Indiana? Please fill out the volunteer application and submit it to: Info@bpindyinc.org.

Thanks!

0 Comments
0 Likes
Statistics
Notes
  • Be the first to comment

  • Be the first to like this

No Downloads
Views
Total Views
230
On Slideshare
0
From Embeds
0
Number of Embeds
1
Actions
Shares
0
Downloads
0
Comments
0
Likes
0
Embeds 0
No embeds

Report content
Flagged as inappropriate Flag as inappropriate
Flag as inappropriate

Select your reason for flagging this presentation as inappropriate.

Cancel
No notes for slide

Transcript

  • 1. 1 Bully Prevention Alliance Volunteer Application Please print clearly and fill out the application completelyName (first, middle, and last) ______________________________________________Home Address _________________________________ Apt/Suite _______________City ________________________ State _________________ Zip _______________Phone Numbers __________________ ___________________ _________________ Cell Home WorkBest time to call: ________________________Email ____________________________________________________________Preferred Method of Communication (please circle): Cell Home Work EmailMale ( ) Female ( ) Date of Birth ________________________________Social Security Number (needed for background check) _________________________Current Employer ____________________________ Position ___________________Work Address __________________________________________________________City __________________________ State ______________ Zip ________________Why are you interested in volunteering with the Bully Prevention Alliance (if you needadditional space please use the last page)?© 2011. U.S. Bully Prevention Alliance. Indianapolis, Indiana.
  • 2. 2 How did you hear about the Bully Prevention Alliance? ( ) Word of Mouth ( ) Other – Please describe _______________________________________________________________I would like to be considered for the following volunteer opportunities (select all thatapply):( ) School Activities ( ) Special Events ( ) Office Help ( ) Other – Please describe______________________________________________________________________________________________________________________________________Please list any languages that you speak, read, and/or write fluently in addition toEnglish:______________________________________________________________________Have you volunteered for other organizations? _____ Yes _____ No (If you checkedYes, please continue below)Organization Name: _____________________________________________________Dates of Service: _______________________________________________________Describe volunteer service:Organization Name: _____________________________________________________Dates of Service: _______________________________________________________Describe volunteer service:© 2011. U.S. Bully Prevention Alliance. Indianapolis, Indiana.
  • 3. 3Please describe any work experience you think might be relevant to our program:Do you have any hobbies or special talents that you may be able to offer as avolunteer?What age group do you enjoy working with the most: (You can circle more than onegroup below)Youth (ages 6 – 12) Teens (ages 13 – 18) Adults (18 & older)Please list three references:______________________________________________________________________ Name Relationship Time Known Phone Number______________________________________________________________________ Name Relationship Time Known Phone Number______________________________________________________________________ Name Relationship Time Known Phone NumberHave you ever been charged with or convicted of the following: (please check yes or no) a) Felony _____ Yes _____ No b) Any crime involving a sexual offense, an assault, or the use of a weapon? _____ Yes _____ No c) Any crime involving the use, possession, or the furnishing of drugs or hypodermic syringes? _____ Yes _____ No d) Reckless driving, operating a motor vehicle while under the influence, or driving to endanger? _____ Yes _____ No© 2011. U.S. Bully Prevention Alliance. Indianapolis, Indiana.
  • 4. 4If you answered “Yes” to any of the previous four items, please explain:Bully Prevention Alliance has my permission to: (please check below)Run a background check on me: _____ Yes _____ NoRun a motor vehicle records check on me if I decide to operate a vehicle on behalf ofthe Bully Prevention Alliance: _____ Yes _____ NoVerify the three references I have provided: _____ Yes _____ No Release for Publication (please initial below)While you are serving as a volunteer for Bully Prevention Alliance, there will beoccasions when you may be photographed and/or videotaped by staff, sponsors,corporate representatives, media, and others. We request permission for yourparticipation. By initialing below, you may choose to grant or deny Bully PreventionAlliance permission to use photographs or videotapes of yourself, alone or in groups, innewspaper articles, newsletters, web site, brochures, special fundraising activities,scrapbook, videos and photo albums for use in public understanding and support ofBully Prevention Alliance’s activities and program. By granting permission below, youhereby release and hold harmless Bully Prevention Alliance from any claims, judgmentsor demands which may arise from the use of the above referenced photographs and/orvideotapes.Please initial your selection below:_________ Yes, I give my permission for participation as described above_________ No, I deny consent for participation as described above.By signing below, I affirm that I have answered all questions truthfully. I understand thatif any portion of this application is found to be intentionally false, I may be denied theright to volunteer for Bully Prevention Alliance.__________________________________________ _____________________ Your Signature Date© 2011. U.S. Bully Prevention Alliance. Indianapolis, Indiana.
  • 5. 5© 2011. U.S. Bully Prevention Alliance. Indianapolis, Indiana.

×