Adult Volunteer Application (Ages 19 and older)

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. Volunteers must live in Illinois/Chicagoland Area.

Details
Position(s) applied for:*
Referal Source*
Other Name of Source:
Name:*
FirstLast
Address:*
Street AddressAddress Line 2CityStateZip Code
Home Phone:*
Must be cell phone
Cell / Pager/ Other:*
Email*
Buisness Phone:
best time to call you at home is:
May we contact you at work?:
If yes, work number:
Best time to call you at work is:
Have you submitted an application here before?:
If yes, give position(s):
Date From:
MM
DD
YYYY
Date To:
MM
DD
YYYY
Have you ever volunteered here before?:
If yes, give dates from:
MM
DD
YYYY
To:
MM
DD
YYYY
Date Available For Volunteer Work
MM
DD
YYYY
Type of work desired:
- On-going
- One Time
Are you able to meet the attendance requirements of the position?: *
Have you ever been bonded?: *
Have you ever plead "guilty" or "no contest" to, or been convicted of a crime?: *
If yes, please provide date(s) and details:
Employment History
Employer:
Employer Address:
Street AddressAddress Line 2CityStateZip Code
Job Title:
Immediate Supervisor:
May we contact employer for reference?:
Summarize type of work performed and job responsibilites:
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:
Educational Background
Name of School
Number of years
Degree or Diploma
Major field or Study
Major field or Study.
GPA
Additional Education
Enter Additional education here.
Applicants Statement:
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.
Signature
Address
Street AddressAddress Line 2CityState / Province / RegionZip / Postal CodeCountry
Website
Website
Phone
This field is for validation purposes and should be left unchanged.

Adult Volunteer Application (Ages 19 and older)

Details

Employment History

Educational Background

Applicants Statement:

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