Volunteer Application | Boys & Girls Club of Delaware County

First Name

Middle Name

Last Name

Other Names Used *

Phone *

Street Address

Apartment, suite, etc

City

State

ZIP

Email Address

Social Security Number

Have you ever been convicted of a criminal offense?YesNo

If yes, please explain:

Relatives employed by B&GC of Delaware County:If any, give dates and position

Have you ever been employed or volunteered at a Boys & Girls Club?If yes, list where and when

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I understand a background profile verification will be conducted in order to ensure the business standards of B&GC OF DELAWARE COUNTY and that its contents will be kept confidential. If I am permitted to volunteer with B&GC OF DELAWARE COUNTY, I authorized the re-investigation of any of the above information, at any time, during my association with the organization.

I hereby acknowledge that I have read and understand the preceding statements

Signature

Date