Volunteer Program Application

Emergency Contact

Education

Availability

Background Information

References

As part of your application, we must have three references. At least one reference must be from someone other than a friend or co-worker (for example, a teacher, therapist, or employer).

We ask that you list your references here, and then when you submit your application to us, we will give you forms to give to your references. Your references should send or fax those forms back to our office.

hereby affirm that all of the information provided on this application is true.

I authorize Franklin County Prevention Coalition . and any law enforcement agency they authorize, to investigate my background to

determine my fitness as a potential volunteer.

I understand that my fingerprints will be submitted to the Tennessee Bureau of Investigation for a full background check to include the FBI, Child Abuse Registry, Sexual Offender Registry, Criminal History, and Orders of Protection Registry.

Furthermore, I understand that my application will be rejected if I have been convicted of, or have charges pending for a felony or misdemeanor

involving a sex offense, child abuse or neglect or related acts that would pose risks to children.

I understand that the information requested in this application will be used only for the purpose of determining my suitability as a Franklin County Prevention Coalition volunteer.

Further, I understand that completion of the training does not guarantee that I will be appointed to a case. If I have successfully completed the training and have met all other requirements, and it has been determined that I am a suitable volunteer, I understand that I will be expected to serve a minimum of one year with the program. If unforeseen circumstances prevent me from fulfilling this obligation, I will submit my written resignation to the Program Director with as much notice as possible.

I am aware of the sensitive and confidential nature of this work, the official documents, reports and other material I will examine in my capacity as a Franklin County Prevention Coalition volunteer. I will discuss these matters

only with those persons directly involved in the case or who will be consulted for their professional knowledge and expertise.

I also understand that if for any reason it becomes apparent that my activities are contrary to the policies, goals and/or philosophy of the Franklin County Prevention Coalition Program, and their desire to provide quality services to Franklin County citizens, my services as a Franklin County Prevention Coalition volunteer will be terminated.