UAY Volunteer Application

How long do you plan to volunteer?*
Are you volunteering to fulfill a requirement?*

Yes: Community ServiceYes: School requirementYes: Job requirementNo
Please disclose charges/pending charges:*
Hours needed*

References

Please list 2 references (unrelated to you) that you have known for at least one year, and your relationship to them. (ex: teacher, minister, coach, family-friend, employer, etc.) *You may also list a UAY staff member if they directly referred you to the volunteer application.*
Reference 1
Reference 1 Name*

First NameLast Name
E-mail*
Phone Number*

Area CodePhone Number
Relationship to you*
Reference 2
Reference 2 Name*

First NameLast Name
E-mail*
Phone Number*

Area CodePhone Number
Relationship to you*
Emergency Contact

In case of an emergency while volunteering, please list a person UAY can contact if necessary.
Emergency Contact Name*

First NameLast Name
Relationship to you*
Phone Number*

Area CodePhone Number

Signature Agreement
I hereby affirm that the information on this application is true and complete to the best of my knowledge, and agree to have any of the statements checked by the organization or its representatives. I understand that providing any false or misleading information or any omissions disqualify me from further consideration as a volunteer and may result in my immediate termination if discovered at a later date.

I authorize representatives of United Action for Youth to conduct a thorough investigation of my activities. I authorize all references provided in this application, as well as any other individuals whom the organization or its representatives may contact, to provide all information they have about me. Furthermore, I agree to cooperate in such an investigation and release from all liability, United Action for Youth, and all persons and entities acting on its behalf, as well as all persons and entities requesting or supplying such information.
My Name*

First NameLast Name
I Agree*

Yes
I hereby give my consent to a representative of United Action for Youth to conduct a check of criminal records in regard to any felony arrests.*

Yes
UAY is a non-profit organization and is required to conduct background checks for all volunteers. Helping to cover the cost of background checks is helpful to us, but not required!
I am willing and able to pay $5.00-$20.00 toward fees

YesNo
Should be Empty: