Volunteer Application Form

Personal Data

Name

Middle Name

This address will receive a confirmation email

Cell Phone

Alternate Phone

Physical Address

Date of Birth

Sex Male Female

Marital Status Single Married Divorced Separated Widowed

Spouse/Significant Other Last Name

Spouse/Significant Other Phone

Spouse/Significant Other First Name

Education

Highest Amount of Schooling Achieved

Employment

Employment Status Employed Full time Employed Part Time Unemployed Retired

Employer

Occupation

How long have you been employed?

Legal

REAL Life Community Services requires that all staff and volunteers have current PATCH and CAC forms on file with our offices. These need to updated every 5 years.

PATCH - Pennsylvania Access to Criminal History (free) https://epatch.pa.gov/home

CAC - Child Abuse Clearance (free) http://www.compass.state.pa.us/cwis/public/home

Child Abuse Clearance

Upload (8MB)

Criminal History

Upload (8MB)

Have you ever been incarcerated? Yes No

Parole or probation? Yes, Parole Yes, Probation No

Terms and conditions of parole/probation

Do you have a restraining order against someone? Yes No

Does anyone have a restraining order against you? Yes No

Any other current legal issues?

Notes

Community Involvement

Are you associated or do you attend any church?

Yes No

If so, which congregation do you attend?

Volunteering

I hereby certify that I am in good physical condition to participate in the volunteer program with REAL Life Community Services. I will not hold REAL Life Community Services or the location where I am serving responsible for any accidents, injuries or losses of property.

Signature & Date

Availability

Please mark the times when you would be willing to serve. There may not be a program planned at a certain time, but new programs may be developed based on knowing that there are people available. While we appreciate family involvement, please only consider volunteering for yourself and when you have reliable childcare so that you can give your time to the program.

Mornings Monday Tuesday Wednesday Thursday Friday Saturday

Afternoons Mondays Tuesdays Wednesdays Thursdays Fridays Saturdays

Evenings Mondays Tuesdays Wednesdays Thursdays Fridays Saturdays

Volunteer Application Form

Description

Please Fix the Following