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Transitions Volunteer Application - Missouri

Transitions Volunteer Application Form. This is a Missouri form and can be used in Family Court 7th Circuit (Clay County) Local Circuit Courts .
 Fillable pdf Last Modified 4/26/2005
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CLAY COUNTY FAMILY COURT TRANSITIONS VOLUNTEER APPLICATION (Print application and mail to: Transitions 351 E. Kansas, Liberty, MO 64068) Name: __________________________________________________________________ (last) (first) (middle) (maiden) Address: ________________________________________________________________ If less than 3 years previous address __________________________________________ Home phone: __________________________ Work phone: ______________________ Pager or Cell phone: _____________________ May we contact you at work? _________ Employment (Present and/or last position) Employer: _______________________________________________________________ Address:________________________________________________________________ (city) (state) (zip) Phone: ___________________ Dates Employed: from_________ to____________ Position held: ______________________ Supervisor: ___________________________ Briefly list your job responsibilities: __________________________________________ _______________________________________________________________________ _______________________________________________________________________ Volunteer Experiences Organization: ____________________________________________________________ Address: ________________________________________________________________ Phone Number: _______________________ Supervisor: ________________________ <<<<<<<<<********>>>>>>>>>>>>> 2 Briefly describe a rewarding experience you had during the time that you volunteered for this organization: _____________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ Organization: ____________________________________________________________ Address: ________________________________________________________________ (city) (state) p) (zi Phone Number: _______________________ Supervisor: _______________________ Briefly describe a rewarding experience you had during the time that you volunteered for this organization:_________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ Special Skills Describe the skills, talents, and/or special training you possess that you believe would be an asset to the Transitions Program: __________________________________________ _______________________________________________________________________ _______________________________________________________________________ Brief Questions About Yourself Can you make a commitment to this Program for at least one year?__________________ If no, please explain: ______________________________________________________ Do you have the following? Your own transportation: ____________ Liability Insurance: _____________________ Valid Drivers License: ____________________________________________________ What is your highest level of education? _______________________________________ What are some your Hobbies/Interests? _______________________________________ How did you hear about the Clay County Transitions Program? ____________________ Would you like us to keep your employer abreast of your volunteer service and achievement? Yes No <<<<<<<<<********>>>>>>>>>>>>> 3 Personal References Please list two (2) professional and/or personal (not including relatives) references with complete address and phone numb.e r(REFERENCES WILL REMAIN CONFIDENTAL) # 1 - Name: _____________________________________________________________ Address: ________________________________________________________________ Phone Number: _______________________ Relationship: ______________________ # 2 - Name: ______________________________________________________________ Address: ________________________________________________________________ Phone Number: _______________________ Relationship________________________ I assert that the information contained herein is, to the best of my knowledge, true and correct. I understand falsification herein will render my application void. _______________________________ _____________________________ Signature of Applicant Date <<<<<<<<<********>>>>>>>>>>>>> 4 CLAY COUNTY FAMILY COURT TRANSITIONS VOLUNTEER PROGRAM Permission to Contact References and Complete Background Investigation I hereby give permission to the Clay County TRANSITIONS PROGRAM to inquire about my qualifications and/or character by: Contacting Personal References named in Volunteer Application Contacting present and/or past employers Contacting present and/or past organizations for which I have performed volunteer services Completing a background check with the Missouri Child Abuse/Neglect Hotline Central Registry Further, I understand that the Clay County Transitions Program will complete a background investigation on me through the Clay County Sheriffs Department or other appropriate and necessary law enforcement agency. INFORMATION NEEDED FOR CRIMINAL RECORD INVESTIGATION Last name: _______________________________ First name: _______________________________ Middle Name: ____________________________ Race: __________________________ Gender: _______________________________ Date of Birth: ___________________ Social Security #: ________________________ State of Birth: ______________ Drivers License #: ____________________________ Aliases or other names used: ________________________________________________ ___________________________ __________________________ Signature of Applicant Date
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