Corrections Volunteer Application

Personal Information

Name *

first and last name

Address *

street address, city, state

Primary Phone # *

ex. 111-222-3333

Secondary Phone #

ex. 111-222-3333

E-mail Address *

Birthdate *

MM-DD-YYYY

Marital Status *

Married

Not-Married

Employment

Present Employer *

Employer Address

Street address, city, state

Start Date

MM-DD-YYYY

Work Phone

Education/Military Service

High School *

City/State *

HS Grad Year

College/University

College Grad Year

Degree

Military Service

Branch

Dates of Service

MM-DD-YYYY - to - MM-DD-YYYY

Criminal History

Are you currently on probation/parole? *

Yes

If you answered Yes, please explain (dates, state, charges, etc.)

If you answer

Have you ever been convicted of a misdemeanor or felony as an adult? *

Yes

If you answered Yes, please explain (date, state/county, duration, outcome, etc

Have you ever been on probation/parole? *

Yes

In case of emergency during volunteer work

Emergency Contact *

first and last name

Relationship *

This contact is related to you in what way?

Daytime Phone *

ex. 111-222-3333

Evening Phone *

ex. 111-222-3333

Just for Fun

If you had to describe yourself in 1 word, what would that one word be? *

What would you like to do as a volunteer? *

Please be specific about working with adults or juveniles. If you’re not sure what you would like to do, please review the volunteer positions descriptions to check out our needs.

Leave this field blank

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Corrections Volunteer Application