Volunteer Information – The Venom Foundation

Venom Foundation Volunteer Information

*Last Name

*First Name

Address

City

State

Zip Code

*Phone Number

*Email

*Date of Birth

Employer

Position

Emergency Contact: Last Name

First Name

Address

City

State

Zip Code

Cell Phone

Because of the sensitive nature of our work, we request the following information:

*Have you ever been convicted of a crime?

Yes

If so, please explain the nature of the offense and where?

*Are there any criminal charges currently pending against you?

Yes

If so, please explain the nature of the offense and where?

*Have you ever been involved in the abuse or neglect of a child or adult?

Yes

If so, please explain the nature of the offense and where?

*Have you ever been involved with a protective service agency?

Yes

If so, please explain the nature of the offense and where?

The information in this application is correct to the best of my knowledge, and permission is given for any investigation necessary. Any untruthful or misleading information provided in this application can lead to dismissal. As a volunteer of this organization, I agree to abide by the policies and procedures. I understand that I will be volunteering at my own risk. The organization, its employees and affiliates, cannot assume any responsibility for any liability for any accident, injury, or health problem that may arise from any volunteer work I perform for the organization. I agree that all the work I do is on a volunteer basis, and I am not eligible to receive any monetary payment or reward.

*Your Signature

Date