VOLUNTEER APPLICATIOIN

Please Print, fill out and return to:

Susie Bowling, 372CR468, Jonesboro, AR 72404
Last_______________________________First______________________________
City_______________________________State__________________Zip_________
Home_______________________________Work_____________Moble__________
E-mail Address_____________________ __________________________________
Please circle one: Male___________ Female___________
Date of Birth______________________ SSN________________________________
Driver's License No._______________ State_________
Employer/School_______________________________________________________
Employer/School Address____________ ___________________________________
What volunteer position are you interested in?________________________________
1.Do you use drugs illegally? Yes______NO_______
2. Have you ever been convicted of a criminal offense? Yes______No_______
3. Have you ever been charged with neglect, abuse or assault? Yes______ No______
4. Has your Driver's License ever been suspended or revoked in any state? Yes______NO______
* In the course of volunteering for Special Olympics, you may become aware of personal information, and you agree to keep said information in the strictest confidence.
* You grant Special Olympics Arkansas permission to use your likeness, voice and words in television, radio, film or any form to promote activities of Special Olympics.
* You understand that the relationship between Special Olympics Arkansas and volunteers is an "at will" arrangement and that it may be terminated at any time, without cause, by the applicant or Special Olympics AR.
Applicant's Signature______________________________________________Date___________ Parent/Guardian________________________________________Date__________
Powered by The Form Assembly

Report Abuse or Spam

Resume Later

In order to be able to resume this form later, please enter your email and choose a password.


Resume a previously saved form