Volunteer Application

Homeschool Academy of South Jersey

This application is to be completed by all those desiring position involving the supervision or custody of minors. It is being used to help HASJ provide a safe and secure environment for our students.

Legal Name:

Address:

Social Security #:

Date of Birth:

Years at this address?

If less than 5 yrs, give previous address

and number of years:

Home Phone:

Work Phone:

Email Address:

Cell Phone:

Occupation:

Place of Employment

Spouses Name:

Occupation:

Emergency contact:

Relationship:

Phone #'s to reach them:

(home, work, cell)

Do you have medical training or are you CPR certified?

References: (must be 21 years old and non-related to you)

Name: ________________________________________

Years known?

Address: ______________________________________

Phone:

Relationship: ___________________________________

Name: ________________________________________

Years known?

Address: ______________________________________

Phone:

Relationship: ___________________________________

Name: ________________________________________

Years known?

Address: ______________________________________

Phone:

Relationship: ____________________________________

By my signature below, I am authorizing Homeschool Academy of South Jersey to process a background check.

Volunteer Signature:

Date:

The following questions are part of our application process to help provide a safe & secure environment for our students. All information is held in strict confidence by HASJ. Answering yes to any question may not necessarily preclude your involvement in HASJ. Thank you for understanding.

Have you had any life experiences that may have better equipped you to work with children? _______

If yes, please explain.

Are there any circumstances involving your life-style or your background that would call into question your ability to work with

Do you use illegal drugs?

Have you ever been hospitalized/treated for alcohol or substance abuse?

Have you ever been accused, arrested or convicted for any of the following:

Criminal Offense ________

Sexually related crime ________

Abuse related crime ________

If you answered yes to any of the above questions, please explain:

What leadership/volunteer experience have you had with children?

List any gifts, training, education, or other factors that have prepared you to work with children:

Office Review: