Text Box:

 

      Volunteer Application

Please type or print clearly.  All information will be treated confidentially.  Please answer all questions as completely as possible.

Personal Information

 

_______________________________________________________________________         _______________________________________________________     _________

  Last Name                                                                                                                 First Name                                                                                MI

______________________________________________________________________________________________________

  Address

__________________________________      _______       _____________       _____________________________________

  City                                                                                State                   Zip                                      County

______________________________________________________________________________________________________

  E-mail Address

 

________________________________       __________________________________       _____________________________

  Home Phone                                                                    Business Phone                                                                Other Phone

Phone Preference:         o Home         o Business          o Other           

Are you employed?        o Yes            o No                    If yes,      o Full time        o Part time

                                    o Retired  (if retired, please list last place of employment)

_____________________________________________________________       _____________________________________

  Employer                                                                                                                                           Occupation

__________________________________________________________       _________________    ________    ___________ __________________________________________________________       _________________    ________   

  Business  Address                                                                                                                      City                                      State                 Zip

Are you a student?         o Yes            o No                    If yes,      o Full time        o Part time

______________________________________________________________________________________________________

  Name of School

Emergency Contact

 

__________________________________________________________       _________________________________________

  Name                                                                                                                                        Relationship

__________________________________________________________       _________________    ________    ___________

  Complete  Address                                                                                                                     City                                      State                 Zip

_______________________________________________                ______________________________________________

  Day Phone                                                                                                                    Evening Phone

Previous Experiences

(Employment, Volunteer or Educational experiences)

                         Organization                                                             Dates of Service                                               Services Performed

___________________________________            ___________________________             ___________________________

___________________________________            ___________________________             ___________________________

___________________________________            ___________________________             ___________________________


Licenses

 (Drivers and professional license)

Type                                                                                 State              Number                                                                 Expiration Date

___________________________________     _______      ___________________________             ____________________

___________________________________     _______      ___________________________             ____________________

 

Area(s) of Interest

Please check the area(s) in which you would like to volunteer.

 

 Administrative/Special Project Support                      Blood Services Driver                    Blood Drive Volunteer                               Community Disaster Education Presenter     Disaster Response                       Health & Safety Instructor

 Learn to Swim Instructor                                               Military Communications              Safety City Volunteer                    

 

American Red Cross Training Certification

 

                Course                                                  Description                                                Date                                         Instructor

                                                                                                                                                                                       

 

                                                                                                                                                                                   

 

                                                                                                                                                                                   

 

Volunteer Availability

 

Days:                       Mon-Fri       Mon          Tues          Wed           Thurs                            Fri          Sat         Sun         Flexible

Times:                Morning                            Afternoon                          Evening

 

Specific hours or time constraint?                                                                                                                                                                         

 

 

 

Have you ever been convicted of a felony, or within the past 24 months of a misdemeanor that resulted in imprisonment?  (a conviction will not necessarily disqualify an applicant)               Yes                    No

 

 

For both references, please select someone not related to you (spouse, in-law, immediate family, fiancé, etc).

           

Reference (Personal) ______________________________________________________________________________________­­­­­­­_

                        Name                                                       Relationship to you                                                  Phone Number

 

Reference (Professional) _______________________________________________________________________________________

Name                                                       Relationship to you                                                  Phone Number

 

My signature denotes that I verify the information provided in this employment application is true, correct, and complete.  I hereby give my consent to the American Red Cross of Licking County to verify this information and regarding my character, including contacting references, and unconditionally release your company from all liability which might result from furnishing same.  I understand that my acceptance as a Red Cross Volunteer is on a conditional basis, with the American Red Cross reserving the right to terminate the service of any volunteer whose conduct in any way reflects negatively upon the American Red Cross.

 

q       (Optional – check if “yes”) I grant full permission to the sponsors, organizers and affiliates to use my name, photographs or any other record of participation in this volunteer service event for use in any broadcast, telecast, or any other written account of the event for publicity purposes, without compensation or remuneration.

 

                                                                                                                                                                                   

Applicant’s Signature                                                                                                                                         Date

 

 

If applicant is under age 18:

I give my permission for my child to participate as a volunteer with the American Red Cross of Licking County.[1]

 

q       (Optional – check if “yes”) I grant full permission to the sponsors, organizers and affiliates to use my child’s name, photographs or any other record of participation in this volunteer service event for use in any broadcast, telecast, or any other written account of the event for publicity purposes, without compensation or remuneration.

 

 

___________________________________________________________________________________________                        ____________________________________

Parent / Guardian Signature                                                                                                                                              Date

 

 

 

 

AMERICAN RED CROSS OF LICKING COUNTY

BACKGROUND CHECK INSTRUCTIONS

 

All American Red Cross employees and registered volunteers must undergo background checks in accordance with established guidelines from NHQ through a single mandatory vendor. If you are a candidate to volunteer, an applicant for employment, or are a Red Cross employee or volunteer who has never received a Red Cross background check, you must do so in order to serve with The American Red Cross.

 

Rod Cook, Executive Director, is the only person at the Chapter who has administrative rights to view the results of the check.  Two types of checks will be conducted:1) a Social Security Number verification and 2) a national Criminal History Check.  NO Credit Checks will be done and there is NO cost to you. 

 

In order to initiate your background check, follow these simple steps:

 

  1. Visit the vendor’s website at: www.MyBackgroundCheck.com/ArcVts/
  2. Read with care your rights and provide your consent to the background check.
  3. Enter personal information as requested, which includes your name, date of birth, social security number, and driver’s license number (if you have one).
  4. Wait to hear about the results from your unit administrator and/or the vendor.
  5. If you dispute the results of the background check for any reason, follow the instructions provided by the vendor.

 

ALL volunteers and employees are required to complete this process in order to continue serving with the American Red Cross.  The only exception to this is if you are a DSHR member and have already completed the background check in order to go out on disaster assignment or if you are under the age of 18.

 

It takes approximately five minutes to complete this process.  If you have any questions or concerns, please contact Rod Cook at 349-9442 or rcook@alink.com.

 


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