VOLUNTEER

Please fill out the interest form below if you’d like to consider volunteering at New Danville. Our volunteer coordinator will be in contact with you soon after.

 

Your Name (required)

Your Email (required)

Main Phone (required)
Type of phone:
Alternate Phone (required)
Type of phone:

Address:

City: State: Zip:

Sex:  Male Female
DOB:

Shirt Size:

Have you worked with people with Special Needs?  Yes No

Please list two personal references:

Name: Phone:
Name: Phone:

In case of emergency, notify:
Relationship:
Home Phone:
Work Phone:
Cell Phone:




ACKNOWLEDGEMENT:
I am aware that serving as a volunteer is a privilege; carrying with it high trust and relation obligations. I agree to fulfill my service commitment and to conform to all rules and regulations of the volunteer service program.

Have you ever been convicted, been on probation or deferred adjudication for any felony or misdemeanor?  Yes No

I hereby certify that all of the information contained on this application is true and complete. I authorize TNCA to verify this information and to check references. I understand that any misstatement or omission on this application is cause for loss of volunteer privileges. I also understand that TNCA will do a background check to validate prior criminal convictions.

I hereby understand that my photograph may be taken for the purpose of promotion of services at New Danville. I am aware that I will not receive payment of any kind for my participation and grant New Danville the rights to use regardless of my future association with the facility and for an unrestricted time.

Check to acknowledge: