Please indicate volunteer interest(s):

PART I: Personal Information

PART II: Employment History

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

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.

PART IV: Program-Specific Information

Tutor/mentor and Visitation Center volunteers:

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

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

Please read this carefully before signing:

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.

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