Volunteer Application
Thank you for your interest in volunteering with Saving Innocence! This form will help us
find out how best you can help. Please answer all questions to the best of your ability and
please print legibly. We look forward to your response.
Contact Information:
Full Name:
Home Address:
City, State, Zip:
Cell Phone:
Social Security No:
Driver’s License No:
Marital Status:
Date of Birth:
Primary Email:
Ethnicity:
Occupation:
Getting to Know You
Briefly explain why are you interested in volunteering for us.
Have you ever worked/volunteered with an organization before? If so, which one and
for how long?
Have you ever worked with youth before?
What are some of your special interests/hobbies?
What skills do you have that you think would help Saving Innocence?
How long have you lived in the area?
Do you speak any foreign languages?
Would you be available for periodic training if asked?
What type of volunteer work you are interested in?
Is there anything else about yourself that you’d like us to know?
Background
Have you, at any time, been involved in or accused, rightly or wrongly, for sexual
abuse, neglect or mistreatment of children or youth?
Yes
No
If yes, please explain:
Have you ever been accused or convicted of possession/sales of controlled abuses
or of driving under the influence of alcohol?
Yes
No
If yes, please explain:
Are you using Illegal drugs?
If yes, please explain:
Yes
No
Have you ever been arrested or convicted of any criminal act? Yes
If yes, please explain:
No
Have you ever been asked to step away from ministry or work with children or youth
in any setting, paid or volunteer?
Yes
No
If yes, please explain:
Is there anything in your past or current life that might be a problem if we found out
about it later?
Yes
No
If yes, please explain:
Have you ever been a victim of any form of child abuse?
If yes, please explain:
Yes
No
Do you have any medical/health conditions or take any medications that might affect
or make your work with youth hazardous for you or them?
Yes
No
If yes, please explain:
Availability
(Please Circle)
Sunday
AM/PM
Monday
AM/PM
Tuesday
AM/PM
Wednesday
AM/PM
Thursday
AM/PM
Friday
AM/PM
Saturday
AM/PM
What kind of time commitment are you looking to contribute?
References
Please provide us 3 personal adult references (outside of family) who are familiar
with your character as it might relate to working with youth.
Name:
Address:
Phone:
How you
know this
person:
Name:
Address:
Phone:
How you
know this
person:
Name:
Address:
Phone:
How you
know this
person:
Work History
Please provide your current and previous employers
Company Name:
Position Held:
Name of Supervisor/ Phone #:
Date of Employment:
Reason for Leaving:
Company Name:
Position Held:
Name of Supervisor/ Phone #:
Date of Employment:
Reason for Leaving:
Company Name:
Position Held:
Name of Supervisor/ Phone #:
Date of Employment:
Reason for Leaving:
From:
To:
From:
To:
From:
To:
Acknowledgement, Release and Signature
I certify that the above statements and answers are true and correct. I acknowledge
that Saving Innocence reserves the right to discontinue the screening process at any
point. The reasons may or may not be disclosed to me. Saving Innocence does not
discriminate on the basis of age, sex, race, color, creed, sexual orientation, national
origin, ancestry, disability or any other protected status.
By signing this document I hereby authorize Saving Innocence and/or it’s agents to
make an independent investigation of my background, references, character,
criminal or police records, including those maintained by both public and private
organizations and all public records for the purpose of confirming the information
contained on my application and/or obtaining other information which may be
material to my qualifications as a volunteer now and, if applicable, during the tenure
of my involvement with Saving Innocence.
I release Saving Innocence and/or it’s agents and any person or entity, which
provides information pursuant to this authorization, from any and all liabilities, claims
or lawsuits in regards to the information obtained from any and all of the above
references sources used.
Signature:
Date Signed:
Thank You! Please email your completed application to:
hannah@savinginnocence.org