Volunteer Application - Arizonans for Children

Volunteer Interest(s)

Tutor/Mentor (21+)

Visitation Center (18+ preferred)

Please indicate volunteer interest(s):

PART I: Personal Information

Date

Gender

Male Female

Full Name

Spouse Name

Maiden Name

Date of Birth

Home Address

State

City

Zip

Home Phone

Cell Phone

Work Phone

Driver’s License Number

State Issued

Have you ever been convicted of a crime?

No Yes

Do you have any health issues or physical conditions that should be noted?

No Yes

Do you have any mental health issues (current or past)?

No Yes

Do you have any substance-abuse issues (current or past)?

No Yes

Do you object to our agency running a background check on you?

No Yes

Education Level

Language(s) spoken

Please describe any previous volunteer experience

What time(s) work best for your schedule?

After School After 5pm Weekends During business hours

Emergency contact

Relationship

Phone

Special training, skills, hobbies

How did you hear about Arizonans for Children?

Friend/relative

Newspaper

AFC Web site

Other Web site

Other

PART II: Employment History

Please provide employment information for the past five years, with most recent position first.

Employer

Address

City

State

Zip

Phone

Your Position/Title

Supervisor’s Name

Supervisor’s Position/Title

Start of Employment

End of Employment

Employer

Address

City

State

Zip

Phone

Your Position/Title

Supervisor’s Name

Supervisor’s Position/Title

Start of Employment

End of Employment

Employer

Address

City

State

Zip

Phone

Your Position/Title

Supervisor’s Name

Supervisor’s Position/Title

Start of Employment

End of Employment

PART III: Personal References

Please list the names, addresses, and phone numbers of three people you would like to use as character references (only people you have known for at least a year). Include one relative. Any information Arizonans For Children (AFC) gathers from these references will be held as confidential and not released to you, the applicant.

Name

Address

State

City

Zip

Phone

Relationship

How Long Known

Name

Address

State

City

Zip

Phone

Relationship

How Long Known

Name

Address

State

City

Zip

Phone

Relationship

How Long Known

PART IV: Program-Specific Information

Tutor/mentor and Visitation Center volunteers:

Please list all members of your household (Tutor/mentor only):

Name

Gender

Male Female

Age

Relationship

Name

Gender

Male Female

Age

Relationship

Name

Gender

Male Female

Age

Relationship

Name

Gender

Male Female

Age

Relationship

Name

Gender

Male Female

Age

Relationship

Please rate your comfort level in working with the following age groups (Tutor/mentor volunteers only):

1 = I prefer working with this age group
2 = I feel pretty comfortable working with this age group
3 = I feel uncomfortable with this age group

K - 5th grade

6th - 8th grade

9th - 12th grade

Tutor/mentors only: Please tell us about any additional background experience, skills, interests, that you have that might enhance your ability to work with a particular child, youth, or teen:

Please read this carefully before signing:

I agree to follow all AFC program guidelines and understand that any violation will result in suspension and/or termination.

I understand that AFC is not obligated to provide a reason for their decision in accepting or rejecting me as a mentor.

I understand that, if selected, I will be asked to review all of the program's rules, regulations, and responsibilities for becoming a mentor. I understand that I will be asked to agree to all policies prior to being matched.

By signing below, I attest to the truthfulness of all information listed on this application and agree to all the above terms and conditions.

I, understand it will be necessary for AFC to conduct a background check regarding my driving record, criminal history, personal references, and employment.

I authorize AFC to obtain any needed information regarding my driving record, legal/criminal history, character references, and employment from any state or federal agency, my employer, and personal references for the purposes of participating in AFC programs. Further, I provide permission for AFC to conduct the same investigation of my background in previous states in which I have resided.

Further, if I am applying for a program involving a one-on-one match, I understand that information about myself will be anonymously (without my name) shared with a prospective foster youth and his/her parent(s)/guardian(s) to aid in determining a suitable match. Once a match is determined, my identity and any other information known about me may be shared with the youth and parent/guardian to ensure a safe and successful mentor relationship.

Agree

Full Name

Address

State

City

Zip

Date of Birth

Current Drivers License No.

State Issued

Please list any other cities, states, and dates of residency during the past 10 years.

City

State

From

City

State

From

City

State

From