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VRC Volunteer Opportunities & Application
Volunteer Opportunities: shelter volunteer, sexual assault volunteer, Foster Pet Care, secretarial volunteer, Special Events Volunteer, Board of Director’s, Community Volunteer. For more information call (315) 331-1171 ext. 306.
Signing this Application constitutes written authorization for our agency to complete a security background check and motor vehicle abstract report if the volunteer position requires driving on VRC business.
Name: ___________________________________________________ (Maiden/birth name): ________________________
City: ______________________________________________________ State: _______________ Zip Code: ___________
Phone numbers: home: ________________________ cell: _________________________ work: ____________________
Email Address: ______________________________________________________________________________________
Social Security #: _______________________________________ Birth Date: ___________________________________
Days and times available: ______________________________________________________________________________
Work Experience: ____________________________________________________________________________________
References: List three names of persons not related to you who can provide information on your abilities relevant to this position. Please list their name, phone number, and years known.
List any strengths, skills, hobbies or interests that you feel are relevant or beneficial to volunteering with the VRC?
What do you know about the crimes of domestic, sexual, stalking, family violence, and/or child abuse?
Do you have a valid driver’s license and reliable transportation? ( ) Yes ( ) No
What types of volunteer service are you interested in doing at the VRC? __________________________________________
Arrest History/Criminal Background: Please list every state in which you have lived. List any arrests, or detainments by any law enforcement agency, and/or any indication by Child Protective Services. List the state, date, reason and outcome.
Have you ever been convicted of any crime other than a felony? ( ) Yes ( ) No
Are you a registered sex offender? (This must be disclosed by law) ( ) Yes ( ) No
“I understand my answers are given voluntarily and if I so desire I may consult an attorney before I sign this form. By my signature below, I fully understand that I have waived my right to consult an attorney. Under penalty of perjury I declare the aforementioned answers true to the best of my knowledge. By my signature below, I authorize the VRC to investigate via local and state police departments my background, criminal history, offender status (if any) and any other fact of my character. I forever hold the VRC, its employees, heirs, family, vendors and anyone else not stated herein and now, harmless for any and all information gathered and reported to the VRC. I understand that a false statement made herein is immediate grounds for termination without notice or cause.”
I, the undersigned, have read, understand and agree to all the terms of this release.
______________________________________________________________ Date ___________________________
Print applicant name clearly
Mail to: Volunteer Coordinator, VRC, 132 Harrison Street, Newark, NY 14513-1234