Volunteer Interest Form

First Name

Last Name

Select a date

Street Address

City

State

Postal / Zip code

Home Phone

Business Phone

Employer

Special Certifications (i.e. CPR, Medical, etc.)

Do you have a valid driver's license?

Yes

If Yes, Driver's License #

In which of the following would you like to participate? Required

Are you willing to participate in mandatory Human Sex Trafficking Training before and during your volunteer position at Learning to Live Beloved Ministries?

Yes

Previous Volunteer Experience (please explain)

Work Experience & Educational Background (please explain)

Have you ever been convicted of or plead guilty to any crime(s)?

Yes

Have you ever been refused participation in any volunteer programs?

Yes

Have you ever received deferred adjudication for an offense or otherwise required to register as a Sex Offender under any state or federal statute?

Yes

If you answered “Yes” to any of the above questions, please provide complete details.

Upload File

If you have a current Pennsylvania State Criminal Background Check, please upload it below.

I certify that all statements on this Application are true and correct. As condition of volunteering, I give permission for Learning to Live Beloved Ministries to conduct a background check on me, which may include a review of sex offender registries, child abuse and criminal history records. I understand that, if appointed, my position is conditional upon Learning to Live Beloved Ministries receiving no inappropriate information on my background. I hereby release and agree to hold harmless from liability Learning to Live Beloved Ministries, their officers, employees and volunteers thereof, or any other person or organization that may provide such information. I also understand that, regardless of previous appointments, Learning to Live Beloved Ministries is not obligated to appoint me to a volunteer position. If appointed, I understand that, prior to the expiration of my term, I am subject to suspension by the President and removal by the Board of Director for violation of Learning to Live Beloved Ministries policies or principles.

Your Signature

Thank you for your interest in Learning to Live Beloved Ministries!