School on Wheels Volunteer Application

School on Wheels Volunteer Application

Personal Information
Name	First Middle Last
Date of Birth
Email
Application Date
Gender	Male Female
Address

	City State Zip Code
Phone (999-999-9999)	Home Work
Phone/Fax (999-999-9999)	Mobile Fax
Preferred Contact Phone	Home Work Mobile
Languages (conversational)
Talents/Skills (e.g. music, art)
Emergency Contact Name	First Last Phone
- Indicates a required field

Education Information
Select highest level completed	If "other", Explain:
- Indicates a required field

Employment Information
Current Employer or School
Address

	City State Zip Code
Position	Years with Company

References
List two references who have known you for at least one year and are not related to you. Please notify your references to expect our call.	Reference #1 Name First Last Relationship
	Reference #1 Phone (999-999-9999) Email

	Reference #2 Name First Last Relationship
	Reference #2 Phone(999-999-9999) Email
- Indicates a required field

Background Security Information
To safeguard the children we serve, School on Wheels screens volunteer applicants. All information is confidential and will not be shared.	I will provide School on Wheels with fingerprint and background check results. Yes No
	HAVE YOU EVER BEEN CONVICTED OF, OR PLEADED GUILTY OR NOLO CONTENDERE (NO CONTEST) TO, A CRIME THAT HAS NOT BEEN EXPUNGED, SEALED, ERASED OR PARDONED? (A conviction includes any plea, verdict or other finding of guilt regardless of whether sentence is imposed by the court.) Yes No
	IF "YES", PLEASE STATE THE NATURE OF EACH OFFENSE AND THE DATE, CITY, STATE AND DISPOSITION (use an additional sheet if necessary):
	NOTE: In answering the above, you should not answer “YES” or otherwise disclose information for: (1) any conviction that occurred when you were a minor that has been expunged or sealed by the court; (2) any misdemeanor convictions for which probation has been completed or otherwise discharged and for which the case has been dismissed by the court; (3) any conviction that resulted in a referral to and participation in any pretrial or post-trial diversion program (Cal. Labor Code § 432.7); and (4) any conviction that pertains to certain marijuana-related offenses that are more than two years old (Cal. Labor Code § 432.8). A CONVICTION WILL NOT NECESSARILY DISQUALIFY AN APPLICANT FROM SELECTION. FAILURE TO PROVIDE ACCURATE INFORMATION COULD RESULT IN DENIAL (OR TERMINATION) OF VOLUNTEER ASSIGNMENT. FURTHER, ALL INDIVIDUALS WHO ARE SELECTED TO PERFORM VOLUNTEER WORK MUST PRESENT EVIDENCE OF CALIFORNIA DEPARTMENT OF JUSTICE/FBI CRIMINAL RECORD FINGERPRINT CLEARANCE AS A CONDITION OF PERFORMING SERVICES FOR SCHOOL ON WHEELS, INC.
	If accepted for volunteer services, can you present evidence of your legal right to reside in the United States during the time you expect to be providing services for School on Wheels? Yes No
	[The Immigration Reform and Control Act prohibits discriminating against applicants based on citizenship status, unless citizenship is a bona fide qualification.]
- Indicates a required field

Terms of Application and Signature (required)
IMPORTANT: PLEASE READ CAREFULLY AND CHECK A BOX BELOW EACH PARAGRAPH BEFORE SIGNING APPLICATION
a. If I am accepted to perform volunteer services, I agree to comply with all rules, regulations, policies and procedures of School on Wheels as they now exist and may be modified from time to time at the sole discretion of School on Wheels. Yes No
b. I understand that, if selected, I will perform academic tutoring to selected students without receiving any monetary compensation or other financial benefits for my services. I understand that if I am selected to perform volunteer services for School on Wheels, it may terminate my assignment at any time, with or without cause, and with or without notice. Yes No
c. I certify that the facts contained in this application, or any other document used for selection purposes as well as any other verbal or written statements made by me during the selection process, are true and complete to the best of my knowledge. Yes No
I certify that I have read each of the foregoing statements and that I understand and agree to adhere to each of them. I AGREE I DO NOT AGREE Please type your full name in the box above
Under the Electronic Signatures in Global and National Commerce Act (E-Sign), the information you submitted on this application is legally binding in the same manner as are hard copy documents executed by hand signature.
What motivated you to volunteer with School on Wheels? Please share anything you would like us to know.


Version 2.4 (01/16/2012)