Volunteer Application

VOLUNTEER BACKGROUND INVESTIGATION CONSENT

* Indicates required field

I hereby authorize Boys & Girls Club of South Logan County and/or its agents to make an independent investigation of my background including, but not limited to, criminal records, police records, and those maintained by both public and private organizations and all public records to confirm the information provided below for the purpose of volunteering with the Boys & Girls Club. I release Boys & Girls Club of South Logan County and/or its agents and any person or entity, which provides information pursuant to this authorization, from any and all liabilities, claims or law suits in regards to the information obtained from any and all of the above referenced sources used. The following is true and complete legal name and all information is true and correct to the best of my knowledge. Choose One *

Yes No

Please type your name as your signature to consent *

First

Last

Date (format Month / Day / Year Example 01/01/2020) *

Full Legal Name *

Maiden Name or Other Names Used *

Present Address *

Line 1

Line 2

City

State

Zip Code

Country

How long at this address? *

Former Address *

Line 1

Line 2

City

State

Zip Code

Country

How long at this address? *

Date of Birth (format Month / Day / Year Example 01/01/2020) *

Drivers License# *

State of License *

Please email a scanned copy/photo of a photo ID (Driver’s License,
Passport, School ID, etc.) to admin@bgcslc.org

We will call you for your Social Security Number upon receipt of the application and email of ID.

Email *

Phone Number *

Have you ever volunteered at another Boys and Girls Club *

Yes, please provide the name of the Club in the box below. No

If applicable, Club Name: *

Have you ever volunteered with another Youth Organization before? (ie, cheer, baseball, etc) *

Yes, please provide details in box below No

If Applicable, name of other Youth Organizations where you have volunteered: *

Please provide two references

Reference #1 *

First

Last

Reference #1 Phone Number *

Reference #2 *

First

Last

Reference #2 Phone Number *

*NOTE: The above information is required for identification purposes only, and is in no manner used as a qualification for volunteering. Boys & Girls Club of South Logan County is an Equal Opportunity Employer, and does not discriminate on the basis of Sex, Race, Religion, Age (40 and over), Handicap or Nation Origin.

Comment *

Submit

Volunteer Application

VOLUNTEER BACKGROUND INVESTIGATION CONSENT

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