Online Application

Application Check List

  1. Application filled out completely
  2. Standards of Conduct read and signed
  3. Release for background check filled out and signed
  4. Check made out to Unite 4 Life for $25 for background check
  5. List of character references provided

ATTENTION: do not navigate away from this page or your information will be lost!

General Information

First Name
Last Name
Email
Home Phone
Cell Phone
Street Address
City
State
Zip Code
Gender
Date of Birth
--

Volunteer Position / Skills

Please check the areas in which you are interested in volunteering:



Classroom Speaker
Mentor
Event Planning
Administration
Please list any specific tasks, positions, or skills with which you would like to help:

Optional Personal Information

We just want to get to know you better!

Work Status
Occupation
Employer
Marital Status
Name of Spouse (if applicable)
Anniversary (if applicable)
--
Do you have any children?
Name of 1st Child
Birthday
--
Name of 2nd Child
Birthday
--
Name of 3rd Child
Birthday
--
Name of 4th Child
Birthday
--

Emergency Contact

Emergency Contact
Emergency Contact's Phone

Emotional Background

Read Emotional Background [popup window]

Have you or a close relative ever suffered from or been treated for any condition that would impact your ability to work with youth in a healthy way?

Character Background

Please provide three character references, one from each area:

Family

Name
Relationship
Years Known
Phone
Email

Employer/Teacher/Volunteer Director

Name
Relationship
Years Known
Phone
Email

Friend

Name
Relationship
Years Known
Phone
Email

Volunteer Standards of Conduct

Read Standards of Conduct [popup window]

I have read the Unite 4 Life Volunteer Standards of Conduct. I understand that, as a volunteer, I will be held accountable to these standards and I commit to upholding them to the best of my ability.

Full Name Electronic Signature
Date
--

Background Check

(This form authorizes Unite 4 Life to obtain background information and must be completed by the applicant. Unite 4 Life must keep this completed form on file for at least two years after requesting a background check)

I, the undersigned applicant (also known as "consumer"), authorize Unite 4 Life through its independent contractor, LexisNexis, to procure background information (also known as a "consumer report and/or investigative consumer report") about me. This report may include my driving history, including any traffic citations; a social security number verification; present and former addresses; criminal and civil history/records; and the state sex offender records.

I understand that I am entitled to a complete copy of any background information report of which I am the subject upon my request to Unite 4 Life, if such is made within a reasonable time from the date it was produced. I also understand that I may receive a written summary of my rights under the Fair Credit Reporting Act.

Full Name Electronic Signature
Date
--

Identifying Information for Background Information Agency
(also known as "Consumer Reporting Agency")

Current Information

First Name
Middle Name
Last Name
Other Names Used (alias, maiden, nickname)
Current Street Address
City
State
Zip Code
County
Date Lived From
--
Date Lived To
--

Former Information

Former Street Address
City
State
Zip Code
County
Date Lived From
--
Date Lived To
--
Driver’s License Number
State
Date of Birth
--
Gender
Social Security Number
--

Electronic Signature

The information contained in this application is complete and correct to the best of my knowledge. I authorize any references listed to give you any information they may have regarding my character and fitness for youth work and I release all such references from liability for any damage that may result from furnishing such evaluations to you. I understand that all information will be held confidential by Unite 4 Life.

Full Name Electronic Signature
Date
--

 

 

 

 

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