Last Name
First Name
M.I.
Date
Street Address
Apartment/Unit #
City
State
ZIP Code
Phone
Email
Are you a citizen of the United States?
YesNo
If no, are you authorized to work in the U.S.?
Ever volunteered for us before?
If yes, when?
Ever been convicted of a felony?
If yes, explain:
Please list three references.
Full Name
Relationship
Company
Address
Name
Please check all that apply.
AdministrationEvent PlanningFundraisingGrant WritingTransportationArts/CraftsPhotographyYard WorkIT SupportChildcareSocial MediaInternshipHealth/WellnessOtherIn-Home Help
Please provide a description of the skills and abilities you would like to provide:
FlyerFriendInternet SearchSocial MediaWebsiteSchoolOther
If other, please specify:
Have you been arrested or convicted of a crime (including DUI)?
If yes, please describe:
Have you ever been convicted of neglect, abuse, or substance dependency?
Do you have a valid driver's license?
State and License #
Expiration Date
Has your driver’s license ever been suspended or revoked?
Would you be willing to sign a Confidentiality Agreement?
Would you be willing to sign a Release of Liability?
I, , hereby affirm that all of the answers provided on my Volunteer Application are true to the best of my ability. I understand that misrepresentations or omission of facts called for is cause for denial. I hereby authorize the Missouri Stop Human Trafficking Coalition to investigate my background and to contact the references provided for the purposes of determining my suitability as a potential volunteer for the Missouri Stop Human Trafficking Coalition.
Typed Signature
[acceptance* application-consent] I certify that the information provided in this application is true and complete.
