7/28/2019 TFP Volunteer Application 2012
1/2
Volunteer ApplicationPlease return to Development
Associateemail:[email protected] fax:
612-339-9150Questions? Call 612-341-1610
Name: Date:
Address:
City: State & Zip:
Telephone (day): Evening or mobile:
Email: Birthday (no year):
How did you learn about volunteering with us?
What volunteer position are you applying for?
EMERGENCY CONTACTName: Relationship:
Telephone (day): Evening or mobile:
CURRENT OR MOST RECENT EMPLOYMENTEmployer: From: To:
Position:
EDUCATION (GED/HIGH SCHOOL DIPLOMA, CERTIFICATION, COLLEGE,
ETC.)
CRIMINAL BACKGROUND (PRIOR ARREST OR CONVICTION MAY NOT EXCLUDE
A PERSON FROM VOLUNTEERING)
Have you ever been convicted of or pleaded guilty or no contest
to a crime: Yes No
If yes, please attach information describing circumstances and
list date of conviction or plea and county and state.
SIGNATUREI understand that submitting this information does not
guarantee my acceptance as a volunteer, and that placement isbased
on assessments made by The Family Partnership staff. I also
understand that acceptance as a volunteer maybe conditioned upon
the results of specific checks made into references and criminal
history, if applicable to theposition. Finally, I understand that
as a volunteer, I will be required to abide by all policies of The
Family Partnership.All volunteers must be able to work effectively
in a mission-driven agency whose clients and staff exhibit
diversity withrespect to race, ethnicity, gender identity, sexual
orientation, socio-economic status, nationality, and religion.
_______________________________________________
______________APPLICANTS SIGNATURE DATE
_______________________________________________
______________PARENT OR LEGAL GUARDIAN SIGNATURE, REQUIRED IF
APPLICANT IS UNDER 18 DATE
I give my consent for this applicant to volunteer with The
Family Partnership (TFP). I release TFP from all liabilityfor
injuries which may occur if the youth volunteer undertakes tasks
that are not assigned by his/her TFP supervisor.
Updated 7/22/10
mailto:[email protected]:[email protected]:[email protected]:[email protected]
7/28/2019 TFP Volunteer Application 2012
2/2
VOLUNTEER DEMOGRAPHICS FORM(this is optional for all potential
volunteers)
The information requested below is voluntary. It will be used to
monitor The Family Partnerships VolunteerProgram's Equal Employment
Opportunity/Affirmative Action plan. Refusal to provide in
information will nothave a negative effect on your status as a
candidate. Please complete and return to the VolunteerCoordinator
or enclose it with your application materials. It will be kept
confidential.
NAME (Optional): __________________________________ DATE:
____________
Type of volunteer position
desired:________________________________________________________________________________
1. Gender: Female Male Other (specify):
________________________
2. Age Group: Under 21 2129 3039 40 49 50 59 60+
3. Race/Ethnic Group (check one):
AFRICAN/BLACK: Persons having origins in Africa (not of Hispanic
origin).
ASIAN: Persons who have origins in the Far East, Southeast Asia,
or the Indian Subcontinent(examples: India, Pakistan, Bangladesh,
Cambodia, China, Japan, Korea, Sri Lanka, Malaysia,Philippines,
Nepal, Thailand, Vietnam, Sikkam, and Bhutan).
HISPANIC/LATINO/CHICANO. Persons of Mexican, Puerto Rican,
Cuban, Central/South Americaor other Spanish culture or origin,
regardless of race.
NATIVE AMERICAN INDIAN or ALASKAN NATIVE: Persons having origins
in any of the originalpeoples of North, South or Central America
who maintain cultural identification through tribalaffiliation or
community recognition and attachment.
NATIVE HAWAIIAN or PACIFIC ISLANDER: Persons having origins in
any of the original peoplesof Hawaii, Guam, Samoa, or other Pacific
Islands.
WHITE/CAUCASIAN: Persons having origins in Europe, North Africa
or the Middle East (not ofHispanic origin).
OTHER/COMBINATION (specify):
______________________________________________
4. Do you consider yourself to have a disability/handicap
according to the following definition of handicap:a) A physical or
mental impairment which materially limits one or more life
activity;b) A record of such impairment; or
c) Regarded as having such impairment.
YES NO
PLEASE RETURN COMPLETED FORM TO:Development AssociateThe Family
Partnership414 South Eighth StreetMinneapolis, MN 55404
