Volunteer Application

GIRL SCOUTS - GREAT RIVERS COUNCIL, INC.

VOLUNTEER APPLICATION

* fields that must be completed in order to submit your application

SECTION I - PERSONAL DATA

First Name:*	Middle Initial:	Last Name:*
Former Name(s):
Current Address:*
City:* State:* Zip:*
Current Home Phone:* Cell phone:
Date current address ends: E-mail address:

Permanent Address (if different):
City: State: Zip:
Permanent Home Phone: Business Phone:

Are you under the age of 18?* No Yes If you are under the age of 18, please state your age:

SECTION II - VOLUNTEER INTERESTS & AVAILABILITY

1. What type of volunteer service interests you?

Other:

2. What time commitment do you desire?

Other (explain):

3. Are you available to volunteer:

4. Specific days you would prefer to volunteer?

5. Specific geographic areas where you would prefer to volunteer? (Please include service unit name, if known)

6. What previous training, experience, or skills do you think you bring to the organization?

7. While serving as a Girl Scout volunteer, how will you strive to make a difference in the lives of girls?

8. How did you learn of Girl Scout volunteer opportunities?

SECTION III - VOLUNTEER EXPERIENCE

Organization:	Position
Dates (From/To)

Organization:	Position
Dates (From/To)

SECTION IV - WORK EXPERIENCE

Current Occupation:	Employer:

Dates (From/To): Employment Status:

SECTION V - EDUCATION

College/University:	Degree:
High School:	Diploma:
Technical Training/Other Language skills other than English:

SECTION VI - REFERENCES*

A reference should be a person (non-relative) who is familiar with your qualifications and/or experiences as they relate to work with youth and adults. We will mail your reference forms from the Girl Scout Center to your references. At least three references must be received and reviewed before appointment to a position can take place. Please provide four references, including complete mailing addresses and phone numbers.

Reference #1

Name:*
*Street Address: Apt. #:**
City:* State:* Zip:*
*Home Phone: Business Phone: E-mail address:**
Relationship to you (Note: reference must be non-related):*

Reference #2

Name:*
*Street Address: Apt. #:**
City:* State:* Zip:*
*Home Phone: Business Phone: E-mail address:**
Relationship to you (Note: reference must be non-related):*

Reference #3

Name:*
*Street Address: Apt. #:**
City:* State:* Zip:*
*Home Phone: Business Phone: E-mail address:**
Relationship to you (Note: reference must be non-related):*

Reference #4

Name:*
*Street Address: Apt. #:**
City:* State:* Zip:*
*Home Phone: Business Phone: E-mail address:**
Relationship to you (Note: reference must be non-related):*

AFFIRMATION AND SIGNATURE

In making my application for service, I express my acceptance of the beliefs and principles of Girl Scouting as stated below in the Girl Scout Promise, the Law, and the Managing Diversity Vision.

The Girl Scout Promise

On my honor, I will try:

To serve God and my country,

To help people at all times,

And to live by the Girl Scout Law.

The Girl Scout Law

I will do my best to be

honest and fair,

friendly and helpful,

considerate and caring,

courageous and strong, and

responsible for what I say and do,

and to

respect myself and others,

respect authority,

use resources wisely,

make the world a better place,

and be a sister to every Girl Scout.

Managing Diversity Vision

Girl Scouts - Great Rivers Council, Inc. will create an inclusive environment where board members, volunteer and paid staff, and girl members are encouraged to serve as catalysts to guarantee that the Girl Scout program is delivered to the diverse population within its geographic area.

The concept of diversity will become a primary mindset which drives all council initiatives such that:

A. Policies, practices, procedures, structures, and activities include both global and domestic diversity dimensions.

B. No girl or adult member is either advantaged or disadvantaged because of disability, ethnicity, race, religion, socioeconomic status, or any other cultural classification.

I promise to uphold and interpret these principles and beliefs to the best of my ability as I fulfill my responsibilities with the organization.
I agree to complete all required trainings necessary to learn about the organization and my position within six months of my appointment date.
I authorize contact of my references to verify my qualifications for placement in a position.
I give my permission for the interviewer to record dictated information in all or part of the application.
I grant my permission and consent for my participation in all photographs, videotapes, likenesses of image or interviews to be published and used to illustrate, promote, and advertise Girl Scouts. Use of any such photographs, videotapes, or interviews may include, but is not limited to, use on Internet web sites promoting the Girl Scouts.

With my electronic signature below, I certify that all of the information provided on this application is true and complete, and that I understand that falsification or significant omissions of any information may be considered justification for non-acceptance or dismissal from my volunteer position if discovered at a later date.

I understand this is my electronic signature:

Type Full Name:*

Date:*

APPLICANT'S CERTIFICATION

Girl Scouts - Great Rivers Council, Inc. requests the following information because of our dedication and commitment to the girls that we serve. All youth-serving organizations must take reasonable precautions when appointing adults who work directly with children. This information is confidential and for internal use only.

Please type "Yes" or "No" below if you have ever been convicted of, or pled no contest or guilty to any of the following:

*Child abuse in violation of Ohio Revised Code Section 2919.24,

*Endangering children in violation of section 2907.04,

*Gross sexual imposition in violation of section 2907.05,

*Sexual imposition in violation of section 2907.06,

*Importuning in violation of section 2907.07,

*Voyeurism in violation of section 2907.08,

*Public indecency in violation of 2907.09,

*Any offense of violence, or any existing or former offense of any municipal corporation, this state, any other state or the United States that is similar to any of the above offenses.

*Any other felony or misdemeanor, including DWI, DUI, but not including minor traffic violations.

If you have been convicted of, pled no contest or guilty to, any of the above, please complete the following information:

Date of conviction: Location:

Nature of offense:

With my electronic signature below, I further certify that: I have never been discharged from employment or a volunteer position because of any activity covered by the above Ohio Revised Code sections. The information provided by me on this form is true and correct to the best of my knowledge. I understand that falsification or significant omissions may be considered justification for non-acceptance or dismissal from my volunteer position.

I agree to complete my criminal history background check as a part of my placement in a volunteer position.

Type full name:* Date:*

There shall be no discrimination against an otherwise qualified adult volunteer by reason of disability, age, race, color, ethnicity, sex, creed, national origin, citizenship, or socio-economic status.