EXPERIENCE, If yes, please describe
Arts & Crafts_____________________________________________________________
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Camping ________________________________________________________________
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Computer________________________________________________________________
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Dance__________________________________________________________________
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Dramatics ______________________________________________________________
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Volunteer Application
3
Musical Instruments _______________________________________________________
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Photography_____________________________________________________________
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Public Speaking __________________________________________________________
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Team Coaching __________________________________________________________
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Tutoring ________________________________________________________________
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Other___________________________________________________________________
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BACKGROUND INFORMATION & INFORMED CONSENT
As a condition of volunteer service with Boys & Girls Clubs of Elgin a successful criminal background investigation is required. Your signature on this application allows BGCE to submit to appropriate law enforcement authorities information in order to disclose the existence of a conviction for the following criminal offenses or a criminal offense equivalent to the following:
(1) Murder; (2) Child Abuse; (3) Rape; (4) A sexual offensive involving a minor, non-consenting adult, or person who is mentally defective, mentally incapacitated or physically helpless; (5) Child Pornography; (6) Kidnapping of a Child or Child Abduction; (7) Child Neglect; (8) Domestic Violence or (9) Unlawful manufacture, distribution or dispensing of drugs or illegal substances.
BGCE reserves the right to decline any candidate's application to volunteer.
HAVE YOU EVER BEEN CONVICTED OF A CRIMINAL OFFENSE INCLUDING BUT NOT LIMITED TO, CRIMINAL NEGLECT, ABUSE OR ASSAULT?
YES NO
DO YOU AGREE TO DISCLOSE ANY FUTURE CRIMINAL CONVICTIONS OR VIOLATIONS?
YES NO
ARE YOU WILLING TO UNDERGO A CONVICTION INFORMATION BACKGROUND CHECK BY THE ILLINOIS STATE POLICE? YES NO
HAVE YOU EVER APPLIED FOR A VOLUNTEER OR PAID POSITION WITH BGCE BEFORE?
YES NO
Please complete the following:
Male/Female
Date of birth: ___________________________________________________________
Ethnic Background (optional):White/ African American/ Hispanic-Latino/ Asian or Pacific Islander/ American Indian or Alaskan
Do you currently have a driver's license? YES NO
Do you have access to a car you can utilize for volunteer work? YES NO
EMERGENCY CONTACT
NAME: ______________________________________________
PHONE: ______________________________________________
RELATIONSHIP: ______________________________________________
