Volunteer Application

Boys & Girls Clubs of Greater Houston, Inc.

Volunteer Application

Date: ___________

Name:__________________________________________________________________

Address:________________________________________________________________

Home Phone:__________________ Work Phone:____________________________

Race:______________ DOB:______________ Gender:_______

Emergency contact:__________________ Relationship:____________ Phone:________

Email Address: ___________________________________________________________

Where did you learn about our volunteer opportunities?____________________________________________________________

If you speak a language other than English, please list here:___________________________________________________________________

Do you have any experience working with children or volunteering?:___________________________________________________________

_______________________________________________________________________

What is your occupation? __________________________________________________

What type of transportation do you use? ______________________________________

The following section will help you determine what volunteer activities you might like to participate in. Please check the area(s) that interest you. I would enjoy:

Tutoring - which subjects? _______________________________________________

Sports Coach/Assistant - which sport? ______________________________________

Arts & Crafts Activity Assistant/Instructor

Helping a child read or reading to them

Assisting with fundraising

Mentoring teens

Helping a child use a computer

Assisting in the game room

Chaperoning a field trip

Assisting the Administrative Office & clerical work

Activities not listed that I’m interested in:____________________________________

Preferences in Volunteering:

Location: Shell Unit, 1520 Airline Drive - (just north of downtown off of I-45)

Morefield Unit, 5950 Selinsky - (southeast side of town, near MLK & Reed Rd)

Spring Branch Unit, 8575 Pitner - (on 290 off Bingle and Hempstead)

Holthouse Unit, 2411 Canal - (near Minute Maid Park on the other side of I-59)

Fort Bend Unit, 5525 Hobby - (on S. Post Oak between Beltway 8 and 2234)

Stafford Unit, 3110 Fifth Street - (on Fifth Street off of Texas Parkway)

Johnny Mitchell Unit, 4420 Avenue P, (Galveston)

NFL YET Center #1, 4900 Providence Bldg., C. (Wheatley High @ Finnigan Park)

NFL YET Center # 2, 10918½ Bentley, (@ James Driver Park (near I-59 & Little York)

Brookshire Branch, 4010 4^th Street, Brookshire

We are open 2:30 p.m. – 8:00 p.m.

Days of the week available: Monday Tuesday Wednesday Thursday Friday (check all that apply)

Time frame available: _______________________________________________

What kind of a time commitment are you able to make? (one time - a year, etc.)

________________________________________________________________________

Are there any physical limitations or are you under any course of treatment which might limit your ability to perform certain types of work? ________________________

References:

Current employer: ________________________________________________________

Address: __________________________________________Phone: ________________

Please list two character references:

Name:___________________________________ Phone: ________________________

Address: ________________________________________________________________

Name: __________________________________ Phone: ________________________

Address: ________________________________________________________________

Understanding and Authorization:

I certify that all the answers on the application and any attachments are true and complete to the best of my knowledge. I also certify that I have not withheld any pertinent information.

I agree in the course of considering my application, you may inquire to verify information considering my background. I specifically authorize you to investigate all statements in this application. I authorize employers and references listed above to give you any and all information concerning my employment and ability to work with children and young people. I further release and hold harmless the Boys & Girls Clubs of Greater Houston, Inc., and references listed above and any law enforcement agency, from all liability and any damages that may result from furnishing this information to you.

Signature: ___________________________________Date:________________________

Please return to: Boys & Girls Clubs of Greater Houston, Inc.; 1520-A Airline, Houston, TX 77009 or fax to 713-868-3703

Employee/ Volunteer Background Check

Please submit this form via fax to 713-868-3703

Club Location (if known): __________________________________

Are you? † Boys & Girls Club Staff OR † an interested Volunteer?

Please include a copy of your Driver’s License and a copy of your Social Security Card. A $10.00 donation is strongly appreciated to help cover the costs of the background check.

Driver’s license #: _____________________ State: ____________

Name (please print):________________________________________________________

(Last) (First) (Middle)

Maiden /Alias Names:_______________ Social Security ______ - _____ - _______

Daytime Phone: _______________________ Evening Phone: ______________________

*Date of Birth: _______/________/________ *Sex: ____ *Race/Ethnicity: _______

*Note: The above information is required for identification purposes only, and is in no manner used as qualifications for employment.

Current Address:___________________ Apt # ___ City: __________State:__ Zip:______

Previous Address:__________________ Apt # ___ City: __________State:__ Zip:______

Have you ever been convicted of a misdemeanor? Y / N Convicted of a felony? Y / N

If yes, please list charge and date of offense:

___________________________________________________________________________

I hereby authorize Boys & Girls Clubs of Greater Houston, Inc. and/or the company of its choice to make an independent investigation of my background, references, character, past employment, education, criminal or police records, including those maintained by both public and private organizations and all public records for the purpose of confirming the information contained on my application and/or obtaining other information which may be material to my qualifications for volunteering or employment.

I release Boys & Girls Clubs of Greater Houston, Inc. and/or the company of its choice and any person or entity which provides pursuant to this authorization, from any and all liabilities, claims or law suits in regard to the information obtained from any and all of the above referenced sources.

I understand that any offer of employment or volunteering is contingent on a satisfactory background investigation. I also understand that this form will be kept in my permanent file if I am employed or if I volunteer. I certify that the following is my true and complete legal name and all information contained herein is true and correct to the best of my knowledge.

Signature:_________________________________ Date:______________