VOLUNTEER Information:

Last Name / First / M.I. / Date
Street Address / Apartment/Unit #
City / State / ZIP
Home Phone / Email Address
Cell Phone / Date of Birth (mm/dd/yy)

EMERGENCY CONTACT INFORMATION:

Last Name / First / M.I.
Relationship / Phone # / Alt. Phone #

BACKGROUND INFORMATION:

Are you now or have you ever been employed by Bucks County Opportunity Council, Inc.? (If yes, please describe)
Yes / No
Are you currently seeking volunteer service to fulfill a community service obligation (school, church, court referred)? Yes No If yes, please describe the service requirements:
Please provide complete information on two references. Professional References preferred.
Reference #1 Name:
Relationship to you:
Contact Phone Number: Contract Email:
Reference #2 Name:
Relationship to you:
Contact Phone Number: Contract Email:

Background information (continued):

Do you have a valid (State) Driver’s License? Yes No
License Number and State: ______Vehicle License Plate Number ______
Vehicle Insurance Company: ______Policy #: ______
DRIVING POSITIONS ONLY

OTHER VOLUNTEER EXPERIENCE:

Please describe any special skills or experiences (Computer programs, languages spoken, marketing, business, writing background, etc.).
(please

BackGround INformation:

Bucks County Opportunity Council volunteers are required to complete background checks every 3 years. If you have clearances from other volunteer positions or employment, please contact Eileen Albillar () so that we can obtain copies. We ask that Volunteers complete their background checks and cover the associated costs. If doing so is a financial burden, please contact the Volunteer Manager. Instructions for obtaining clearances follow this application.
Child Abuse History Clearance- Free for volunteers
Criminal History Report- Free for volunteers
FBI Background Clearance (Fingerprints)- $27.50 OR waiver form if applicable
Driver History Record $9 (if applicable)
Clearances can be obtained online:
Child Abuse, Criminal and FBI: http://www.dhs.pa.gov/provider/childwelfareservices/childabusehistoryclearanceforms/index.htm#.VpaisfkrK70
PA Driver History (Driving positions only): https://apps.pa.egov.com/idr

VOLUNTEER UNDERSTANDING:

I am volunteering my services to Bucks County Opportunity Council, Inc. I agree that I will perform these services for civic, charitable or humanitarian reasons; a “personal purpose or pleasure”; or to gain employment contacts or a practical work experience without promise, expectation, or receipt of compensation and without any coercion or pressure from Bucks County Opportunity Council, Inc. or any other person or entity.
Signature: / Date:
BCOC Volunteer Application / 2016