| Contact Information |
| First Name: |
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| Last Name: |
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| Address: |
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| City: |
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| State: |
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| Zip: |
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| Primary Phone: |
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| Email: |
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| Background Information |
| Age: |
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| Place of Employment: |
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| Title: |
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| Years Employed: |
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Contact for Emergencies
(name and phone): |
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| Have you ever been arrested, charged or convicted of a felony or misdemeanor resulting in imprisonment or a fine of over $500 in the last ten (10) years? |
| No Yes |
| If yes, please explain: |
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| Have you, a relative or household member ever been charged, arrested or convicted of abuse, neglect, sexual assault or molestation against a child? |
| No Yes |
| If yes, please explain: |
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| Have you, a relative or household member ever had any involvement with the Juvenile Court or the illegal use or sale of illicit drugs? |
| No Yes |
| Are there any health related issues we should be aware of? |
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| Volunteer Information |
| Are you interested in volunteering on a regular basis with Elon Homes and Schools for Children? |
| No Yes |
| If yes, please mark which types of activities you would be interested in: |
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| All agency volunteers who come on a regular basis (this is for ongoing volunteers, not those who volunteer for one event) must undergo a complete criminal record check. |
| I give my consent for Elon Homes and Schools for Children to complete a criminal background check. |
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Please fill out this form to apply for a volunteer position.