Blue Ridge Assembly Volunteer Form

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BLUE RIDGE ASSEMBLY VOLUNTEER APPLICATION

Complete the form, then click "Submit" at the bottom when finished

Name
Date of birth:		Social Security Number:
Address
City	State		Zip
Phone Number:
Email Address:
Do you have a driver's license?		Yes No
Driver's License State:		Driver's License Number:
Citizen of which country:

What is your first choice of dates to work?
to
Second choice?
to
Third choice?
to
Have you worked for Blue Ridge before?	Yes No
If yes, when?
to
Have you ever been convicted of a crime?	Yes No
If yes, please provide details (A 'yes' answer does not automatically disqualify you from employment). The date and nature of the offense and the jobs for which you are applying will be considered.)
List church, school, business, and civic groups in which you have been involved.
List pertinent information: addition skills, languages, hobbies, awards. Do NOT include organizations or memberships which might reveal race, national origin, disabilities, or other protected information.
What specifically attracts you to Blue Ridge Assembly?

Please indicate the position(s) which interest you at Blue Ridge:
First Choice	Second Choice	Third Choice

I certify that the information contained in this application is true and accurate to the best of my knowledge. I understand that falsification of this application in any detail is grounds for dismissal or disqualification from further consideration. I hereby authorize YMCA Blue Ridge Assembly to contact my previous employers and my personal references, and I understand that the Assembly may choose to conduct a background investigation which may involve contacting some or all of the following sources: Criminal Court Clerk, Department of Human Services and any relevant state bureau. I hereby authorize all of these sources to release information about me, and I understand that YMCA Blue Ridge Assembly may contact ther sources not listed herein.

I agree to conform to the rules and policies of YMCA Blue Ridge Assembly and understand that my employment and compensation can be terminated, with or without cause, at any time, at the option of either the Assembly or myself. I understand that no representative of YMCA Blue Ridge Assembly has any authority to enter into any agreement for any specified periods of time unless the agreement is in writing and signed by the Chief Executive Operator, Operations Director, or Staff Development Director.

YMCA Blue Ridge Assembly
84 Blue Ridge Circle
Black Mountain, North Carolina 28711
www.blueridgeassembly.org
828.669.8422