8/6/2019 Cml Volunteer

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VOLUNTEER BIO(Please Print Clearly)

Full Name: _________________________________________ Date of Birth: ____________

Address: _______________________________

City: __________________________ State: ____ Zip: _____________

Home Phone: ______________ Work Phone: ______________ Cell Phone: _____________

E-mail: _____________________________________

Emergency Contact: __________________________________

Relationship: ________________________ Phone: _____________________

Employment Status: (Please check one)

[ ] Full-time [ ] Part-time [ ] Retired [ ] Student

Skills and Interests:

Do you have any special training or skills that you could apply to your volunteer area of interest?

Talents and/or Hobbies?

Drivers License number and state: _________________________________________

References: (former employers, friends )

Name _______________________________________ Phone __________________________

Name _______________________________________ Phone __________________________

Signature required on reverse side

Time Monday Tuesday Wed. Thursday Friday Saturday Sunday

10:00am -

12:30pm

12:00pm -

2/3:00pm

3:00pm -

5:15pm

Availability: Please fill in all that apply. Summer hours may change.

8/6/2019 Cml Volunteer

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CONSENT FOR CRIMINAL BACKGROUND HISTORY CHECK

AUTHORIZATION/WAIVER/INDEMNITYI HEREBY GIVE MY PERMISSION FOR THE CHILDRENS MUSEUM OF THE LOWCOUNTRY TO OBTAIN INFOR-

MATION RELATING TO MY CRIMINAL HISTORY RECORD THROUGH THE MAYORS OFFICE FOR CHILDREN,YOUTH AND FAMILIES IN CHARLESTON, SC. THE CRIMINAL HISTORY RECORD, AS RECEIVED FROM THE RE-

PORTING AGENCIES, MAY INCLUDE JUVENILE OFFENSES, ARREST AND CONVICTION DATA, AS WELL AS,PLEA BARGAINS AND DEFERRED ADJUDICATIONS. I UNDERSTAND THAT THIS INFORMATION WILL BEUSED, IN PART, TO DETERMINE MY ELIGIBILITY FOR AN EMPLOYMENT/VOLUNTEER POSITION WITH THISORGANIZATION. I ALSO UNDERSTAND THAT AS LONG AS I REMAIN AN EMPLOYEE OR VOLUNTEER HERE,

THE CRIMINAL HISTORY RECORDS CHECK MAY BE REPEATED AT ANY TIME. I UNDERSTAND THAT I WILLHAVE AN OPPORTUNITY TO REVIEW THE CRIMINAL HISTORY AND A PROCEDURE IS AVAILABLE FOR CLARI-FICATION, IF I DISPUTE THE RECORD AS RECEIVED.

________________________________________ _______/________/________APPLICANT'S SIGNATURE DATE DATE OF BIRTH

________________________________________ __________-________-_________

PLEASE PRINT NAME SOCIAL SECURITY NUMBER

Please return all completed paperwork to: Volunteer CoordinatorChildrens Museum of the Lowcountry25 Ann StreetCharleston, SC 29403

Or fax to: 843-853-1042

Background Verification:

Where have you lived in the last 2 years: _________________________________________________________

Have you ever been convicted of a criminal offense? If yes, please explain. _______________All background information will be kept confidential, but may determine your eligibility. All volunteers will have to be screened by an FBI/SLEDcheck.

Do you have any physical limitations or are you under any course of treatment which might restrict your ability todo certain types of work? Please explain and list restrictions.