Name *

First Name

Last Name

Phone Number *

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Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Date of Birth *

MM

DD

YYYY

Emergency Contact Phone Number *

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Availability *

When are you able to volunteer?

Monday

Tuesday

Wednesday

Thursday

Friday

Where would you like to volunteer? *

Sacred Suds

McLaughlin Grows Urban Farm

Bethany Housing Rehab

Youth Empowerment Project (YEP)

Community enCompass Main Office

Criminal History Disclosure and Authorization Declaration *

Community enCompass reserves the right to perform a criminal background check of volunteer applicants. No applicant will be denied volunteer service solely on grounds of conviction of a crime. The nature of the offense, the date of the offense, the surrounding circumstances, and the relevance of the offense to the position will be considered.

I hereby authorize Community enCompass to conduct a criminal history background check for the purpose of employment or volunteer services. By providing my information on this form, I agree that this authorization, in original or copy form, is valid for all current and future criminal background checks related to my service with Community enCompass and that any information obtained will be used only in connection with my service to Community enCompass.

Contacts Name *

First Name

Last Name

Contacts Phone Number *

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