Adult Volunteer Application- Group Adult Volunteer Application Groups Step 1 of 2 50% ORGANIZATION PRIMARY CONTACTADDRESS MAILING ADDRESS PRIMARY CONTACT #PRIMARY CONTACT EMAIL ADDRESS CITY STATE ZIP CODE PHONE #Does anyone in your group have any physical or medical limitations? Yes No Please select area(s) of interestFrequency: weekly bi-weekly every other week monthly Time per Frequency: 1 hr 2 hrs 3 hrs Day of Week: Monday Tuesday Wednesday Thursday Friday Saturday Sunday Time of Day: morning afternoon evening Preferred: Uniquely Yours Woodshop Botanical Gardens Activities in the Community Other Areas of Interest: Add RemovePlease list your special skills, talents, and interests: Add RemovePlease list all individuals in your group (Click the + if more entries are necessary):NamePhone #Email Add RemoveIndividualNamePhone #Email Add RemoveIndividualNamePhone #Email Add RemoveIndividualNamePhone #Email Add RemoveSIGNATURESIGNATURE DATE MM slash DD slash YYYY DATE Thank you for your interest. Applicant will be called by Volunteer Coordinator. STRiVE CONSENT FORM FOR BACKGROUND CHECKApplicant, please complete the following: (Complete only if your group will be working directly with individuals in service)The following information is required by law enforcement agencies and other entities for positive identification when checking records. It is confidential and will not be used for other purposes. Full Name (last, first, middle): Other names used Add RemoveDate of Birth: MM slash DD slash YYYY Driver’s License #: State of Issue: Race: Asian Black Hispanic White Other Sex: Male Female List address(es) for the past five years Include city, state, zip code, and how long you lived there. List current address first.(Required)AddressCityStateZip Code Add RemoveAddress(es) ListAddressCityStateZip Code Add RemoveAddress(es) List (Click on + if more Addresses are needed)(Required)AddressCityStateZip Code Add RemoveSIGNATUREBy signing the below, I hereby authorize STRiVE to contact me and my listed references and use the information entered on this form for the Volunteer Application process and file/information storing. I also authorize STRiVE to perform a Criminal Background Check. In connection with this request, I authorize all corporations, former employers, credit agencies, educational institutions, law enforcement agencies, city, county, state, and federal courts, military services and persons, CBI, and FBI, to release information they may have about me to the person or their agent or company with which this form has been filed. This releases the aforesaid parties from any liability and responsibility for collecting the above information. This authorization, in original form or copy form, shall be valid for this and any future reports or updates that may be requested. I authorize the procurement of my Colorado Worker’s Compensation files or any other states’ Worker’s Compensation files. I also authorize a consumer credit report to be run. I understand these files may contain negative information about my background, mode of living, character and personal reputation. This authorization, in original form or copy form, shall be valid for this and any future reports or updates that may be requested. DATE MM slash DD slash YYYY DATE Volunteer Coordinator Requesting: Ext NameThis field is for validation purposes and should be left unchanged. Δ