Volunteer Application

Family YMCA of Marion & Polk Counties

Volunteers are considered without regard to race, color, national origin, gender, age, sexual orientation, physical or mental disability, or any other bias protected by federal, state, or local legislation concerning equal opportunity employment. Every volunteer is subject to a criminal background check.

Personal Information

Name

Phone

Address

Address 2

City/Town

State/Province

ZIP/Postal Code

Country

Are you 18 years of age or older?

Yes

Emergency Contact - Name & Phone Number

For what program or area would you like to volunteer?

Please describe any relevant skills or training

References

Please list three personal references:

Name

Relationship

Phone Number

Name

Relationship

Phone Number

Name

Relationship

Phone Number

Volunteer Statement

Have you ever volunteered for the YMCA of Marion & Polk Counties before?

Yes

If yes, please provide details

Have you ever been employed by the YMCA of Marion & Polk Counties before?

Yes

If yes, please provide details

If selected as a volunteer, would you agree to sign a Volunteer Code of Conduct?

Yes

Applicant Agreement

I certify that the information in the application is correct and complete to the best of my knowledge.
Acceptance into the volunteer program with the YMCA of Marion and Polk Counties is contingent upon satisfacrory pre-placement procedures which include, but may not be limited to, an interview, verification of references, criminal background check, and training.
I realize that misrepresentation of facts will be cause for rejection of this application. In the event of placement in the volunteer program, falsification of any information on the application will be cause for dismissal.
I authorize the YMCA of Marion adn Polk Counties to verify the information provided on this appliation and to conduct a criminal background check. I will hold no person liable for giving or receiving information regarding this application.
I agree to abide by the policies of the YMCA of Marion and Polk Counties.

Signature of Applicant

Sign above

Date

Signature of Parent

Sign above

Date

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