Volunteer Application
Please print and return to administrative staff
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.
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.
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 children?_____________________________________________________________
ability to work with children?_____________________________________________________________
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:________________________________________________________________________
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Updated: July 08, 2011.
___________________________________________________________________________________
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| For your convenience, you can download the Volunteer Application in .PDF format. You will need to have the Adobe Acrobat Reader installed on your computer. Volunteer Application.pdf |