PERSPECTIVES INC. FAMILY CENTER, VOLUNTEER APPLICATION
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Fill out this form online, print off each page, sign it, and fax or mail it in.
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REFERENCES: Please list three non-relative references. References will be contacted by mail.
Name:
Phone:
Address:
City:
State:
Zip:
Relationship:
Name:
Phone:
Address:
City:
State:
Zip:
Relationship:
Name:
Phone:
Address:
City:
State:
Zip:
Relationship:
Have you ever been charged with a crime?
Yes:
No:
(If yes, explain below)
TRANSPORTATION:
Are you willing to drive/provide transportation?
Yes:
No:
(If yes, please answer the following questions):
Type/year of vehicle:
License #/State:
Exp:
Auto Insurance Co:
Policy #
Have you ever been convicted of a moving traffic violation?
No:
Yes:
AGREEMENT FOR VOLUNTEERS

I verify that the information on this application is true, complete and correct, and I understand that if it is not, I am disqualifying myself for a volunteer position. I agree to hold Perspectives, Inc. Family Center harmless for any possible injuries that might result from my participation in volunteer activities. I authorize the above references to give Perspectives Inc. any pertinent information they may have and authorize investigation of all statements contained herein.
Signed:
Date:
Perspectives'
Staff:

Date:

A criminal background check will be conducted on all applicants, as well as a license background check, if you are providing transportation. Please return this form to: Attention Volunteer, Perspectives, Inc., 3381 Gorham Ave., St. Louis Park, MN 55426. If you have any questions, please call 926-2600.

PROBLEMS? CALL 952-926-2600 x-64