RHODE ISLAND MILITARY ORGANIZATION (RIMO)
Check list -THREE items are needed:
1. 2.

□ You must obtain a background check, (BCI) (instructions below) □ An Airport Lounge application must be filled out.(see attached)
 Emailed to: RIMOvolunteer@gmail.com or  Mail to: RIMO, 2000 Post Road, Suite 13 Post Rd., Warwick, RI 02886, or  FAX to: 401 -721-2230

3.

□ You must attend a brief Volunteer training session
Dates and times are being scheduled. Contact RIMOvoluteer@gmail.com for latest class schedule

VOLUNTEER APPLICATION FORM

Last Name: Address: Occupation or School: Address: Phone(s) Home: E-Mail Address:

First Name: City: City: Cell: Work: Fax Number:

Middle: State: State: Zip: Zip:

Emergency Contact Name: Relationship: Phone(s) Home: Cell:: Work: Paid & volunteer work experience beginning with most recent OR attach a résumé)
Organization Name (Paid/Volunteer) Address Phone Dates

Paid

Volunteer

Paid

Volunteer

Education and Training (highest level achieved) - Name of Institution: Degree/Major Dates Attended City/State: List language(s) other than English with which you are completely fluent (Speak, Read & Write) (include sign language) Please write times available M ON TUE WED THUR FRI SAT SUN

7:00 am to 11:00 am 11:00 am to 3:00 pm 3:00 pm to 7:00 pm 7:00 pm to 10:00 pm

RIMO Form Sept 2013

Page 1 of 2

A "yes" answer to the following italicized questions does not necessarily disqualify an applicant: Have you ever been convicted of a felony or misdemeanor? paper). If yes, please explain (you may use a separate

Why do you wish to volunteer with the Rhode Island Military Organization?

References - Three required. Individuals must be over 21 years of age. Home and/or cell phone numbers with area code required. Please avoid work and school contacts who cannot receive a message as this delays the process. No family members or significant others. 1. Name:
2. Name: 3. Name: Phone: Phone: Phone:

VOLUNTEER CONSENT FOR REFERENCE AND BACKGROUND CHECKS
I do hereby give the Rhode Island Military Organization permission to inquire into my educational background, references, driving records, police records, employment and/or volunteer history. I further give permission to the holder of any such records to release the same to the Rhode Island Military Organization. I do hereby hold the Rhode Island Military Organization harmless from any liability, whether civil or criminal, that may arise as a result of the release of this information about me. I further hold harmless any individual, agency, business, or corporation that provides information or documents to the Rhode Island Military Organization. I understand that the Rhode Island Military Organization will use this information as part of its verification of my volunteer application and periodically for evaluation purposes.

________________________________________________________________________________________ Volunteer Signature Date

Please submit by Email to: RIMOVolunteer@gmail.com By regular mail to: RIMO, 2000 Post Rd., Warwick, RI 02886 By fax to: 401-721-2230

For RIMO use only:

RIMO Form Sept 2013

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Don't know how to get a background check? It's easy.
Apply in Person at the Attorney General's Office - 150 South Main Street, Providence, RI 02903 You must bring with you the following: 1. Photo identification: a. State Issued Driver's License or b. State Issued Identification Card or c. Passport 2. Check or money order (NO CASH) for $5.00 payable to BCI

Apply by Mail Mail to: Attorney General, 150 South Main Street, Providence 02903. 1. Fill out the attached disclaimer and HAVE IT NOTARIZED. For your convenience, disclaimer is below) 2. Attach a copy of ONE of the following photo identifications: a. State Issued Driver's License or b. State Issued Identification Card or c. Passport 3. Check or money order (NO CASH) for $5.00 payable to BCI 4. A self addressed stamped envelope for return (if mailed)

Name: _________________________________________ (Print or Type) Maiden Name: ___________________________________

D/O/B: _________________________________________

DISCLAIMER

I _______________________________________________________ Hereby direct and authorize the Bureau of Criminal Identification for the Department of Attorney General for the State of Rhode Island to make available to (your name)________________________________any criminal record that the Bureau of Criminal Identification has on file in reference to me. I hereby waive and release any and all manner of actions, cause of actions, and demands, of every kind, nature and description, arising from any release of criminal records and requests there from, whatsoever against the State of Rhode Island, bureau of Criminal Identification, the Attorney General, an employees of the Attorney General's Office in both law and equity with I may now have or in the future may have.

_______________________________________ Signature of Applicant

Sworn to before me in the City of ____________________State of __________________________________this ____________day of _____________, 2012.

____________________________________ Notary Public ____________________________________ Commission Expires NOTE: Copy of photo identification with date of birth must accompany this Disclaimer.

 

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