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OUR FAMILY SERVICES
VOLUNTEER/INTERN APPLICATION
All information you provide is confidential and will be used solely for the screening and placement process
within Our Family Services. It is the policy of Our Family Services to grant volunteers and interns the same
respectful consideration we give our paid staff. After completing this application, please return it to:
Community Relations Coordinator at Our Family Services 2590 N. Alvernon, Tucson, AZ 85712
If you have any questions about this application please call (520) 323-1708 x 416.
In accordance with state and federal law, Our Family Services will not discriminate against an employee,
applicant for employment, volunteer or intern because of race, disability, color, creed, religion, gender, gender
identity, age, national origin, ancestry, citizenship, veteran status, marital status or sexual orientation.
Reasonable accommodation and alternative format is available on request.
Thank you for your interest in Our Family Services!
Date: ____________
Name: ____________________________________________________________________________________
(Last)
(First)
(M.I.)
Address: __________________________________________________________________________________
(Street)
(City)
(State)
(Zip)
Home Phone #:__________________Work Phone #:__________________Cell Phone#: __________________
Email address: ____________________________________ Are you 16 years or older? ______Yes ______No
Some of our programs legally require and employee/volunteer/intern to be 21 or older – do you meet this
requirement? _______ Yes _________ No
Emergency Contact: Name _______________________________ Address_____________________________
____________________ Phone Number ________________________ Relationship _____________________
Driver’s License Number: ____________________________State:
Exp. Date: ______________
Car:
(Make)
(Model)
(Color)
(License #)
Are you bilingual? ______ Yes ______ No
Fluent Languages - Spoken: ___________________________Written:_________________________________
EDUCATION
High School Diploma or G.E.D. completed? ______ Yes ______ No
College Degrees In-progress/Completed (if In-progress, please indicate “Projected Year” completion date.)
(Projected Year)
ASSOCIATE’S _______ Major: __________________________________ Year Grad._______or __________
BACHELOR’S _______ Major: __________________________________ Year Grad._______or __________
MASTER’S
_______ Major: ___________________________________Year Grad._______or__________
CURRENT EMPLOYMENT STATUS
Current Employment: Full time ________Part Time ________ Unemployed ________ Retired ________
Current Employer: _____________________________________ Address _____________________________
____________________________ Contact Person _________________________ Phone #________________
Job Title/Description: ________________________________________________________________________
EMPLOYMENT/VOLUNTEER/INTERNSHIP HISTORY
You may attach another sheet or your resume. Previous experience (Paid or Volunteer)
POSITION
COMPANY
DUTIES
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
Please list 3 personal references:
(Name)
(Address)
(Phone #)
1. __________________________________________________________________________________
2. __________________________________________________________________________________
3. __________________________________________________________________________________
PLACEMENT DATA
Please complete the following:
I am especially interested in working with clients who ____________________________________________
I have difficulty working with clients who ______________________________________________________
I want to be part of a program where I __________________________________________________________
I am especially interested in the issue(s) of ______________________________________________________
I want to Volunteer/Intern because ____________________________________________________________
_________________________________________________________________________________________
VOLUNTEER OPPORTUNTIES
Please check the opportunities listed below in which you would consider participating:
Administration
___ Clerical and administrative support
___ Indoor cleaning and maintenance
___ Outdoor grounds and maintenance
___ Special events (occasional)
___ Development/fundraising services
Programs
___ Providing services for conflict resolution or group facilitation.
___ Providing counseling services for youth, families or seniors.
___ Providing outreach services to homeless or street youth and runaways.
___ Providing activities and support for youth and young families in residential programs.
___ Providing assistance with children’s activities.
___ Providing support and companionship to seniors.
___ Providing special skills or talents/ Please describe: ____________________________________________
Please list your availability:
Morning
Afternoon
Evening
Morning
Afternoon
Evening
Monday
AM:_______ PM:_______ PM:________
Friday
AM:______ PM:_______ PM: ______
Tuesday
AM:_______ PM:_______ PM:________
Saturday AM: ______ PM: _______PM: ______
Wednesday
AM:_______ PM:_______ PM: ________ Sunday
Thursday
AM:_______ PM:_______ PM: ________
AM: _______PM: _______PM: ______
How often will you be available?
Weekly ______ Bi-weekly______ Monthly______ Other __________________________________________
For how many weeks/months will you be available? _______________________________________________
YOUR FIELD-EXPERIENCE NEEDS
You may attach supplementary internship information from your university. Our Family Services reasonably
accommodates your internship requirements. If you are intending to complete an Internship, Work study, or
Practicum, please list the school:
_________________________________________ Contact Information: ______________________________
BACHELOR’S-LEVEL: Our varied opportunities will be discussed within the Screening Interview.
MASTER’S LEVEL: ____ total hours, from ________to _______, which translates into ______hours per week.
Describe your expectations of the field experience: ________________________________________________
__________________________________________________________________________________________
LEGAL INFORMATION
State law requires that certain staff and volunteer/intern positions are fingerprinted and that a subsequent
criminal history inquiry yields no record of crimes against children and other specified felonies and
misdemeanors.
Have you ever been convicted of a felony? Yes __________ No __________
Have you ever been convicted of a misdemeanor? Yes __________ No ____________
If yes, please explain (conviction of a crime does not automatically exclude you from our program):
__________________________________________________________________________________________
__________________________________________________________________________________________
Have you ever been arrested for child molestation/abuse offenses? Yes __________ No __________
If yes, please explain: ________________________________________________________________________
__________________________________________________________________________________________
Are you or anyone in your family currently involved with Juvenile Court, Child Protective Services, or Our
Family Services?
Yes __________ No __________
If yes, please explain: _____________________________________________________________________
_______________________________________________________________________________________
AUTHORIZATION
To ensure that individuals who are accepted into the Volunteer/Intern Program are a good match for the
organization and its mission, Our Family Services reserves the right to conduct inquiries to verify the information
provided in this application. I certify that the information contained in this application is true and complete to the
best of my knowledge and belief. I authorize investigation of all statements contained in this application. I
understand that any misrepresentation or omission of fact requested may be cause for exclusion or dismissal from
this program. If accepted into the Volunteer Program. I agree to abide by the rules and policies of Our Family
Services.
I voluntarily assume full responsibility for any risks or loss, property damage or personal injury that may be
sustained by me, or loss or damage to property owned by me, as a result of participation in volunteer activities. I
hereby release, waive, discharge and covenant not to sue Our Family Services from any and all liability, claims,
demands, action and causes of actions whatsoever arising of or related to any loss, damage or injury, that may be
sustained by me, or to any property belonging to me, while participating in volunteer activities. I understand that
I and my property are not covered by any liability, medical or automobile insurance held by Our Family Services.
_________________________________________________
(Signature of Applicant)
________________________
(Date)
__________________________________________________
(Printed Name of Applicant)
Signature of Parent, Guardian or Group Leader, if applicable: ________________________________________
CONFIDENTIALITY STATEMENT
FOR
OUR FAMILY SERVICES
Confidentiality and Privacy:
Volunteers should respect the privacy of clients and hold in confidence all information obtained in
the course of professional service.
a.
Volunteers should not share with others personal information revealed by clients unless
for compelling reasons of health and safety, or as required by law.
b.
Volunteers should obtain informed consent of client before videotaping, photographing
or permitting third-party observation of their activities.
c.
Volunteers have an obligation to their clients to refrain from discussing said clients with
any other person not currently associated with direct client service except when
professionally necessary.
d.
After a volunteer has left, she/he is still bound by the above privacy and confidentiality
limits, i.e. she/he may not disclose information about residential or aftercare clients to
others except as permitted in this policy.
e.
Volunteers may not give clients their personal contact information.
Any breach of the above confidentiality statement may be grounds for immediate action.
_________________________________________________
(Signature of Applicant)
__________________________________________________
(Printed Name of Applicant)
________________________
(Date)
Media Consent Form
By signing this release form, I/we hereby authorize Our Family Services, Inc., to use my/our name,
photographs, verbal quotes, audio, video footage or any other form of media taken of/provided by me/us. These
images and/or words may be used by Our Family, its programs and program partners for newsletters, reports,
videos, displays, social media postings and other public relations purposes.
By signing this release form, I release Our Family from any liability in connection with the use of this
information that I/we provide in written, verbal, graphic or other formats.
Name(s):
Address:
City:
State:
ZIP:
Email Address:
Includes minor(s) under 18
 Yes
 No
Signature:
(Signature of legal guardian required for minors under 18)
Date:
Witness:
Date:
Rev. 11/14