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Volunteer Application

Please return to Development Associate email: randerson@thefamilypartnership.org or fax: 612-339-9150 Questions? Call 612-341-1610
Name: Address: City: Telephone (day): Email: How did you learn about volunteering with us? What volunteer position are you applying for? Evening or mobile: Birthday (no year): State & Zip: Date:

EMERGENCY CONTACT
Name: Telephone (day): Relationship: Evening or mobile:

CURRENT OR MOST RECENT EMPLOYMENT
Employer: Position: From: To:

EDUCATION (GED/HIGH SCHOOL DIPLOMA, CERTIFICATION, COLLEGE, ETC.)

CRIMINAL BACKGROUND (PRIOR ARREST OR CONVICTION MAY NOT EXCLUDE A PERSON FROM VOLUNTEERING)
Have you ever been convicted of or pleaded guilty or no contest to a crime: Yes No

If yes, please attach information describing circumstances and list date of conviction or plea and county and state.

SIGNATURE
I understand that submitting this information does not guarantee my acceptance as a volunteer, and that placement is based on assessments made by The Family Partnership staff. I also understand that acceptance as a volunteer may be conditioned upon the results of specific checks made into references and criminal history, if applicable to the position. Finally, I understand that as a volunteer, I will be required to abide by all policies of The Family Partnership. All volunteers must be able to work effectively in a mission-driven agency whose clients and staff exhibit diversity with respect to race, ethnicity, gender identity, sexual orientation, socio-economic status, nationality, and religion.

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APPLICANT’S SIGNATURE

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DATE

_______________________________________________

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PARENT OR LEGAL GUARDIAN SIGNATURE, REQUIRED IF APPLICANT IS UNDER 18 DATE I give my consent for this applicant to volunteer with The Family Partnership (TFP). I release TFP from all liability for injuries which may occur if the youth volunteer undertakes tasks that are not assigned by his/her TFP supervisor.
Updated 7/22/10

Pakistan. Samoa. Bangladesh. ASIAN: Persons who have origins in the Far East. regardless of race. Korea. Gender: Female Male 21 –29 Other (specify): ________________________ 30 –39 40 – 49 50 – 59 60+ 2. Cuban. Nepal. MN 55404 . and Bhutan). or other Pacific Islands. Thailand. NATIVE AMERICAN INDIAN or ALASKAN NATIVE: Persons having origins in any of the original peoples of North. North Africa or the Middle East (not of Hispanic origin). NAME (Optional): __________________________________ DATE: ____________ Type of volunteer position desired: ________________________________________________________________________________ 1. Persons of Mexican. Cambodia.VOLUNTEER DEMOGRAPHICS FORM (this is optional for all potential volunteers) The information requested below is voluntary. Southeast Asia. OTHER/COMBINATION (specify): ______________________________________________ 4. Puerto Rican. or the Indian Subcontinent (examples: India. WHITE/CAUCASIAN: Persons having origins in Europe. Malaysia. HISPANIC/LATINO/CHICANO. Philippines. Do you consider yourself to have a disability/handicap according to the following definition of handicap: a) A physical or mental impairment which materially limits one or more life activity. Age Group: Under 21 3. NATIVE HAWAIIAN or PACIFIC ISLANDER: Persons having origins in any of the original peoples of Hawaii. Refusal to provide in information will not have a negative effect on your status as a candidate. Guam. It will be used to monitor The Family Partnership’s Volunteer Program's Equal Employment Opportunity/Affirmative Action plan. Sri Lanka. Vietnam. Sikkam. Central/South America or other Spanish culture or origin. YES NO PLEASE RETURN COMPLETED FORM TO: Development Associate The Family Partnership 414 South Eighth Street Minneapolis. China. Race/Ethnic Group (check one): AFRICAN/BLACK: Persons having origins in Africa (not of Hispanic origin). or c) Regarded as having such impairment. b) A record of such impairment. Japan. It will be kept confidential. South or Central America who maintain cultural identification through tribal affiliation or community recognition and attachment. Please complete and return to the Volunteer Coordinator or enclose it with your application materials.