Emergency Contact Information
Education and Experience
References - This reference should be from a non-family member (teacher/professor, supervisor, employer, former employer, etc.
Statement of Understanding & Confidentiality Agreement
By electronically submitting this volunteer application I agree that all statements on the volunteer application are true and accurate; any misrepresentation or omission of facts may result in termination or disqualification. I agree to give The Parenting Place permission to contact the references listed above and release The Parenting Place from any liability as a result of such contact. I understand that all internship placements are contingent upon successful completion of the mandatory training/orientation and background check.
By electronically submitting this volunteer application as a volunteer/intern of The Parenting Place indicates that I do hereby understand that everything said in the context of employment/volunteering with The Parenting Place is confidential. However, please keep in mind that an exception to confidentiality is when there is a need to REPORT SUSPECTED CHILD ABUSE OR NEGLECT as required by law. As a volunteer, you may have access to private records or medical information. All information from clients should be treated as confidential and shall be discussed with authorized personnel only. Volunteers shall also treat official agency business as confidential and shall not discuss or impart any information regarding agency business with any person who is not an employee of The Parenting Place without approval of the immediate supervisor.
Permission to Conduct Background Check
For the safety of our clients, staff and volunteers, we require that all employees and volunteers complete a criminal background check. By answering the questions below and adding your electronic signature, you agree to submit to a criminal background check and a check of the Central Registry for Child Abuse and Neglect. The result of your background check may affect your ability to serve on our staff.
Your background check and personal information will be kept securely by the Volunteer Coordinator at The Parenting Place. If you have any questions about the usage of your information or the background check process, please email email@example.com.
PRE-TRIAL INTERVENTION APPLICANTS WILL BE CHARGED THE $8 IT COSTS RUN THEIR BACKGROUND CHECK.
The following information is needed for these procedures: