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Date of Application:
11/21/2008
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* Denotes Required Fields
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Equal access to programs, services and volunteerism is available to all persons.
Those applicants requiring reasonable accommodation to the application and/or interview
process should notify a representative of the Volunteer Services Department.
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Details:
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Position(s) applied for:*
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Referral Source:*
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Other Name of Source:
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Name (First, MI, Last):*
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Home Address:*
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City:*
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State:*
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Zip:*
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Home Phone:*
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Cell/Pager/Other:*
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Email:*
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Business Phone:
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If necessary, best time to call you at home is:
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May we contact you at work?:
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If yes, work number:
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Best time to call you at work is:
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Have you submitted an application here before?:
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If yes, give position(s):
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Dates:
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Have you ever volunteered here before?:
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If yes, give dates from:
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To:
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Date available for volunteer work:
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Type of work desired:
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Are you able to meet the attendance requirements of the position?:
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Have you ever been bonded?
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ANSWERING "YES" TO THE FOLLOWING QUESTION DOES NOT CONSTITUE AN AUTOMATIC BAR TO
VOLUNTEERISM. FACTORS SUCH AS DATE OF THE OFFENSE, SERIOUSNESS AND NATURE OF THE
VIOLATION, REHABILITATION AND POSITION APPLIED FOR WILL BE TAKEN INTO ACCOUNT.
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Have you ever plead "guilty" or "no contest" to, or been convicted of a crime?:
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If yes, please provide date(s) and details:
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Employment History:
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Provide the following information of your current employer, assignment or volunteer
activities.
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Employer:
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Address:
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City:
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State:
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Zip:
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Phone:
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Job Title:
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Immediate Supervisor:
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May we contact employer for reference?:
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Summarize type of work performed and job responsibilites:
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Skills and Qualifications:
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Summarize any special training, skills, licenses and/or certificates that may qualify
you as being able to perform job-related functions in the position for which you
are applying:
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Educational Background:
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Applicant Statement:
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I certify that all information I have provided in order to apply for and secure
volunteer work with OMNI Youth Services is true, complete and correct.
I understand that any information provided by me that is found to be false, incomplete
or misrepresented in any respect, will be sufficient cause to (i) cancel further
consideration of this application, or (ii) immediately discharge me from the organization’s
service, whenever it is discovered. I understand that the organization does not
unlawfully discriminate in volunteerism and no question on this application is used
for the purpose of limiting or excusing any applicant from consideration for volunteerism
on a basis prohibited by applicable local, state or federal law. If I am accepted,
I understand that I am free to resign at any time, with or without cause and without
prior notice, and OMNI reserves the same right to terminate my service at any time,
with or without cause and without prior notice, except as may be required by law.
This application does not constitute an agreement or contract for volunteerism for
any specified period or definite duration.
I understand that volunteers, working directly with children, are obligated
to complete fingerprinting for a DCFS background check. Mentoring programs also
require a valid Driver’s License and Proof of Liability Insurance.
DO NOT SIGN UNTIL YOU HAVE READ THE ABOVE APPLICANT STATEMENT.
I certify that I have read, fully understand and accept all terms of the foregoing
Applicant Statement.
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Signature:
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Date:
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11/21/2008
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Submit
Cancel
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