Volunteer Application Form – Dubuque Dream Center

DDC Volunteer Application

First Name

Middle Name

Last Name

Gender

Male

Female

Prefer not to say

Social Security

Date of Birth

Are you over 18?

Yes

Phone Number

Home Address

Address Line 1

Address Line 2

City

State

Zip Code

EMPLOYMENT HISTORY. Please provide your employment history.

EMPLOYMENT HISTORY. Please add attachment, if available.

Choose File

VOLUNTEER REFERENCES. Please provide the information for three people who have known you for a minimum of 2 years.

VOLUNTEER REFERENCES. Please add attachment, if available.

Choose File

VOLUNTEER EXPERIENCE. Please list your volunteer experiences with other churches or organizations.

VOLUNTEER EXPERIENCE. Please add attachment, if available.

Choose File

VOLUNTEER OPPORTUNITIES + TIMES

Our volunteer opportunities and times are listed below. Upon acceptance, you'll have the opportunity to finalize your availability. Our volunteer commitment policy is minimum 1-2 days/week at a minimum of 1 hour/day.

Academic Center | Monday-Thursday: 4:00-6:00pm

Boys Basketball | Mondays and Thursdays: 4:00-7:00pm

Girls Basketball | Tuesdays and Wednesdays: 4:00-7:00pm

Youth Choir | Tuesdays and Wednesdays - 4:00-7:00pm

Have you previously volunteered with a youth-serving organization?

Yes

If so, what organizations?

What is it that interests you in volunteering at the Dubuque Dream Center?

Describe previous experiences you have had in similar volunteer/work opportunities.

Do you have any skills or certifications that would help you in serving our youth?

Describe your areas of interest/hobbies.

Have you ever been convicted of a criminal offense?

Yes

If yes, please explain.

Have you ever engaged in or been accused or convicted of child abuse, indecency with a child, or injury to a child?

Yes

If yes, please explain.

Have you been treated for any nervous or mental illness?

Yes

If yes, please explain.

Have you ever gone through any treatment for drug or alcohol abuse?

Yes

If yes, please explain.

This position may require you to walk up and down flights of stairs and lift up to 10 lbs. Are you able to perform these activities?

Yes

If yes, please explain.

This position may require you to walk up and down flights of stairs and lift up to 10 lbs are you able to perform these activities?

Yes

Would you like to meet with the Dubuque Dream Center Executive Director regarding any of these issues?

Yes

N/A

What is it about working with children or youth that interests you?

Describe a time that you have had to deal with a child or youth having behavior problems. How did you handle the situation?

The Dubuque Dream Center does not allow the use of physical punishment such as spanking. Would it be difficult for you to follow this policy? Please explain.

Describe types of children or situations involving children you would not feel comfortable having in your group.

Describe your philosophy for how best to minister or impact children and youth.

You are leading a group activity which requires participants to hold hands. One of the youth in your group says that he does not like to hold hands and refuses to participate. How would you respond?

Is there any fact or circumstance involving you or your background that would call into question your being entrusted with the supervision, guidance, or care of children or youth?

Yes

If yes, please explain.

Have you ever been convicted of a criminal offense (felony or misdemeanor?) Answer “Yes” if you have entered a plea agreement including a deferred sentence or deferred judgment arrangement in connection with a criminal case.

Yes

If yes, please explain.

Have you ever been charged with a sexual offense, offense relating to children, or crime of violence?

Yes

If yes, please explain.

Have you ever been the subject of a civil lawsuit involving sexual misconduct, violence, or injury, involving adults or children?

Yes

If yes, please explain.

Have you ever been reported to any organization or registry for abuse or misconduct involving children?

Yes

If yes, please explain.

Do you have any disciplinary action or investigation pending by an employer, other organization, professional association, or licensing body, for violence, sexual misconduct, or misconduct involving children?

Yes

If yes, please explain.

Have you ever been disciplined or dismissed from any volunteer position or employment following an allegation of sexual misconduct, physical aggression, verbal aggression, or other inappropriate behavior or conduct?

Yes

If yes, please explain.

Have you ever been the subject of a complaint or disciplinary proceeding against any professional license or professional affiliation held by you?

Yes

If yes, please explain.

Any final comments or questions?

THANK YOU.

The Dubuque Dream Center appreciates your willingness to share your gifts and talents. Sharing these gifts are appreciated by our staff and organization. Providing safe and secure programs for all the members of the Dubuque Dream Center is a top priority for our organization. The information gathered in this application is designed to help us provide the highest quality programming for our members, youth, and volunteers.

Please put your initials in the box below each statement.

I declare that all statements contained in this application are true and that any misrepresentation or omission is cause for rejection of my application, or dismissal from my ministry involvement.

I understand that I must be interviewed and recommended by a staff of the Dubuque Dream Center before I begin my volunteer service.

I understand that the Dubuque Dream Center has a ZERO TOLERANCE FOR ABUSE and takes all allegations of abuse seriously. I further understand that the Dubuque Dream Center cooperates fully with the authorities to investigate all cases of alleged abuse. Abuse of clients is grounds for immediate dismissal and possible criminal charges.

I declare that I am not a pedophile or child molester and that I have not perpetrated physical abuse, sexual abuse, emotional abuse, or neglect against a child or an adult and that I have never been accused of these acts.

I understand that my references will be contacted and that a criminal background check will be conducted. I authorize investigations of all statements contained in the application.

I agree to observe all of the Dubuque Dream Center’s guidelines and policies for the program in which I am applying. I am willing to be trained, supervised, and reviewed by the Director. I understand that I will be considered as important as a staff member, and will be expected to assume responsibilities as directed by the Director, including attendance of training sessions when needed.

I understand that I can withdraw from the application process at any time.

I understand and agree that false statements and/or omissions regarding past conduct and/or present situation may be grounds for denial of the application to provide volunteer services and that refusal to inform the Dubuque Dream Center of the contents of a sealed criminal record will result in the automatic denial of the application.

Liability Acknowledgment and Waiver Form

By submitting this application you agree to the information below:

I consent to the information I submit being true, and do hereby wish to participate in the activities at the Dubuque Dream Center located at 1600 White Street, Dubuque, Iowa.

ACKNOWLEDGMENT: I hereby understand and acknowledge that this is an activity that incorporates discipline and supervision during participation. I additionally understand and acknowledge that the instructors are mature and intelligent, and will use wisdom and caution to minimize the possibility of accidental injury. However, because of the type of activity involved, I also understand and acknowledge that the prospect of bodily injury while participating in the activities at the Dubuque Dream Center is a possibility even under the most stringent and safest conditions.

WAIVER: Having understood and acknowledged the above, I hereby waive any and all of my rights pertaining to any and all liability for injuries that are a proximate result of participation in the said activities, that are not against public policy, in relation to the Dubuque Dream Center.

My signature indicates that I have read and understand the above.

Signature

Date