Family Bridge Visitation and Community Services Center-Volunteer Application-12012016

Family Bridge Visitation and Community Services Center Volunteer Application
Important Information Regarding Application Process.

Please allow aprox. 30 minutes to complete the application.

Once you start the process, please complete the application in one setting as you will not be able to save and return to the application later.

To complete the application you will need drivers license, references, employment and volunteer history in advance.
Our Mission:

To provide a safe, secure, and home-like environment to assist and support children and families who have been affected by abuse, neglect, divorce, and/or separation in rebuilding family relationships through supervised visitation and neutral exchange services.

Family Bridge Visitation and Community Services Center - Douglasville, GA
"Restoring Family Relationships"

Personal Information - Step 1
Full Name *

First Name Last Name
Social Security Number
E-mail *
Phone Number *

Area Code Phone Number
Alternate Contact Number

Area Code Phone Number
Nick Names/Aliases
Drivers License # and State of Issue
Date of Birth- Note: Minimum Age of 21 to Volunteer *

Month Day Year
What is Your Primary Language?
Do You Speak Other Languages? If Yes, Which Languages?
Current Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country
How Did You Learn of Our Program?
How Long Have You Lived in the Area?
Emergency Contact Person
Emergency Contact Phone Number

Area Code Phone Number

Volunteer Position Desired - Step 2
Position Desired *
Can you commit to at least 12 hours per month? *

Yes No

Educational History - Step 3
Have you completed High School or GED equivalent?

Yes No
Name
City
State
Years Attended
Education Level-Check All that Apply

Some College College Graduate Masters Degree Doctorate/Prof .Degree N/A
Name
City
State
Years Attended
Subjects Studied
Name
City
State
Years Attended
Subjects Studied

Training and Skills - Step 4
Subjects of special study/research work or special training/skills

Personal Philosophies- Step 5
Write a short summary in paragraph form about your interest in volunteering and how you hope to benefit from the volunteer experience. *
Briefly explain in paragraph form what led to your decision to apply for the Family Bridge volunteer position. What attracted you to this particular program? *
What questions do you have about the Family Bridge Visitation program?

Employment History - Step 6
Please state your most recent or current employer.
Employer
Employed From

Month Day Year
Employed To

Month Day Year
Position
Duties
Please state your next most recent employer.
Employer
Employed From

Month Day Year
Employed To

Month Day Year
Position
Duties
Please Indicate Any Other Status From the Drop Down List

Volunteer Experience- Step 7
Please state any past or current volunteer work
Agency
Volunteered From

Month Day Year
Volunteered To

Month Day Year
Position
Duties
Agency
Volunteered From

Month Day Year
Volunteered To

Month Day Year
Position
Duties
Agency
Volunteered From

Month Day Year
Volunteered To

Month Day Year
Position
Duties

References & Authorization - Step 8
Do You Consent to a Background Check? i.e., Sex Offender, Child Abuse, Criminal History

Yes No
Have You Ever Been Convicted of a Crime, Other Than a MinorTraffic Violation? If Yes, What Was the Charge?
Give the names of 3 people not related to you, whom you have known for at least 1 year.
1.
Full Name *

First Name Last Name
E-mail *
Phone Number *

Area Code Phone Number
Years Known
How do you know this person?
2.
Full Name *

First Name Last Name
E-mail *
Phone Number *

Area Code Phone Number
Years Known
How do you know this person?
3.
Full Name *

First Name Last Name
E-mail *
Phone Number *

Area Code Phone Number
Years Known
How do you know this person?
Do you have a resume you would like to upload?

Yes No
Upload your resume
Electronic Signature *

First Name Last Name
Application Completed *

Month Day Year Hour Minutes AM/PM Option
By clicking the submit button, I certify that I have made no willful misrepresentations, omissions or falsifications in this application, and that the entries made by me above are true, complete, and correct to the best of my knowledge. Any willful misrepresentation or falsification in this application will cause my disqualification for participation in the program and/or immediate termination, if discovered later.

Family Bridge reserves the right to disqualify any applicant who would not be appropriate for the Family Bridge program. Any applicant found to have been convicted of either a felony or misdemeanor involving a sex offense, child abuse or neglect, or related acts that would pose risks to children or the Family Bridge program’s credibility is not accepted as a Family Bridge volunteer. Family Bridge further reserves the right to terminate any volunteer who is inappropriate for the program.

Any applicant who is found to have committed a misdemeanor that is unrelated to or would not pose risk to children and would not negatively impact the credibility of the Family Bridge program may be considered.

I authorize investigation of all statements contained herein and the references listed above to give you any and all information concerning any pertinent information they may have, personal or otherwise, and release the organization from all liability for any damage that may result from utilization of such information. I understand and agree that Family Bridge Visitation and Community Services Center or authorized agency make a thorough investigation of my past employment and activities and I release from liability or responsibility all persons and organizations supplying such information. I further understand that a state and federal agency record check with police and child protective services may be conducted as part of the application process and I give Family Bridge Visitation and Community Services Center or an authorized agency permission to make such a check in order to investigate my suitability for volunteer partcipation.
I have read and agree to the above statement *

I agree
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Family Bridge Visitation and Community Services Center Volunteer Application