Operation

 

Name *
Name
Date of Birth *
Date of Birth
Phone *
Phone
Address *
Address
Availability
Monday
Tuesday
Wednesday
Thursday
Friday
Sunday
Interested position *
Previous volunteer service
Background in interested subject/subjects
Name
Relationship to you
Phone/Email
Name
Relationship to you
Phone/email
Occupation
Organization
Starting Date
Ending Date
Name
Relationship to you
*
Phone
By checking the below boxes, I agree that *
Signature
Signature
Criminal background check
Criminal Background Check: Waiver Statement It is the policy of Circle of Friends for Mental Health to conduct criminal background checks on all individuals interested in volunteering with the organization. Volunteers in many programs work unsupervised with individuals from our community and occasionally in the school system. For this reason, criminal background checks are necessary to protect the Foundation, the community and the volunteers. The criminal background check will only be used to establish whether or not a potential volunteer has a criminal record within the State of Washington. If a potential volunteer does have a criminal record, s/he will not be placed in certain programs. However, if appropriate, another placement may be considered. This request for a criminal history is performed through the Washington State Patrol and is free of charge to non-profit organizations. All information obtained is and will remain completely confidential. In the case of a criminal record, you will be contacted and given an opportunity to discuss your volunteer placement. If Washington State Patrol reports no criminal record, you will be able to begin your volunteer assignment once you have attended orientation. Have you been convicted of a crime in the State of Washington? *
I have read the above statement and give my permission to the Washington State Patrol to send all criminal record information pertaining to me to: Circle of Friends for Mental Health 4731 15th Ave NE, Ste. 323 Seattle, WA 98105 *
I have read the above statement and give my permission to the Washington State Patrol to send all criminal record information pertaining to me to: Circle of Friends for Mental Health 4731 15th Ave NE, Ste. 323 Seattle, WA 98105
Signature
Date *
Date