Confidential Volunteer Application

Confidential Volunteer Application
Thank you for your interest in volunteering with StreetLightUSA. We have a variety of openings on an ongoing basis and desire to match you with the most suitable opportunity. The form below will take about 10-15 minutes to complete and there is a list of other documents to submit at the end.

Once you have submitted your form, follow the link to sign up for an open orientation date.
Date of Application

Month Day Year
Personal Information
Full Name *

First Name Last Name
Date of Birth *
Cell Phone Number

Area Code Phone Number
Alternative Number

Area Code Phone Number
Email
example@example.com

Address *

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

When did you move to this address? *

Month Day Year
Date
How long have you resided in Arizona? *
Primary Language *

English Spanish Signing
Secondary Language

English Spanish Signing
Experience and Education Information
Employment Status *

Full Time Part Time Not employed Retired Looking for work Not looking
Place of Employment *
Job Title *
Previous Employment: *
If self-employed or retired- since what date?

Month Day Year
Date
Current Schooling Status *

Part-Time Full Time Not in school
Where do you attend school? (If not in school you can leave line blank)
Highest Level of Education *
Name of Place of Worship (If applicable)
City and State of Place of Worship
Do you have volunteer experience? *

Yes No
How many years experience have you had working with children? *
years
Current community activities, memberships, etc. *
Brief description of hobbies, interests, skills, and areas of training/expertise *
Have you applied for a job or volunteered with StreetlightUSA in the past? *

Yes No
If Yes, please describe
Date available to begin volunteering/interning

Month Day Year Hour Minutes AM/PM Option
Volunteer Interest
Please be aware, any position working directly with our residents requires a minimum of six months to a year commitment depending on position. Direct Care roles also require additional certifications and trainings and are a minimum age of 21 years old.
Support Roles *

Admin Support Front Desk Support Housekeeping/Cleaning Donation Organizing/ Inventory Facilities
Direct Care Roles *

Mentor Tutor Direct Care Aide
Other/Offsite *

Social Media Data Entry Special Events Ambassador
I am willing to commit to volunteering for: *

1-3 months 3-6 months 6-12 months One year or more
Preferred work location *

On site Off site From home
Available times--select all that apply *

Mornings Afternoons Evenings Weekdays Weekends
Referred by *

Church Colleague Flyer Friend Internet School
Background Information
Do you have a valid Driver’s License? *

Yes No
Criminal History Have you ever been arrested or convicted of a crime (including a DUI)? *

Yes No
If Yes, please describe
Have you ever been convicted of neglect, abuse or substance dependency? *

Yes No
If yes, please describe
Do you currently hold a Department of Public Safety Level 1 Arizona Fingerprint Clearance Card? *

Yes No
References
Please list three (3) references. If you are employed, one reference should be from your employer. PLEASE DO NOT LIST RELATIVES OR ANYONE LIVING IN THE SAME HOUSEHOLD!
Full Name *

First Name Last Name
Phone Number *

Area Code Phone Number
Relationship *
E-mail *
Full Name *

First Name Last Name
Phone Number *

Area Code Phone Number
Relationship *
E-mail *
Full Name *

First Name Last Name
Phone Number *

Area Code Phone Number
Relationship *
E-mail *
Employment Contact Info:
Name of Contact
Phone Number *

Area Code Phone Number
Email
example@example.com
I understand that I will also need to submit the following if accepted for a position on campus. Direct Care and Mentoring positions require additional certifications. Please check each to indicate acknowledgment. *

Current level 1 fingerprint clearance card Criminal History Affidavit (needs to be notarized) Current health assessment verifying that you are free of communicable disease; recent TB Test results Valid government issued photo ID Assumption of Risk/Waiver and other in-house forms
I, *
, hereby affirm that all of the answers provided on my application are true. I understand that misrepresentations or omission of facts called for is cause for dismissal. I hereby authorize StreetlightUSA to investigate my background and to contact the above given references for the purposes of determining my suitability as a potential volunteer/intern.
Internet Signature *
Date

Month Day Year
Enter the message as it's shown *
Click to edit
E-mail *
Email
example@example.com
Should be Empty:

Confidential Volunteer Application

Personal Information

Experience and Education Information

Volunteer Interest

Background Information

References