Name *

First Name

Last Name

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Date of Birth *

Volunteers must be 25 years or older.

MM

DD

YYYY

U.S. Citizen? *

Yes

No

Phone *

(###)

###

####

Available Start Date *

MM

DD

YYYY

Have you applied for a job or volunteer position with NSI before? *

Yes

No

What position(s) are you applying for?

Life Skills

Tutoring

Nutrition + Cooking Education

Cooking Assistance

Arts + Crafts

Recreational Activities

Devotionals

Driver/Chaperone

How many hours are you available to volunteer per week? *

1-2 hours

2-4 hours

4-6 hours

I am currently: *

Employed

Unemployed

Retired

A Student

Other (please explain below)

Have you previously volunteered/worked with an organization working with survivors of sex trafficking, abuse, or exploitation? *

Yes

No

How would you describe your knowledge about human trafficking? *

I've heard of this overseas, but I don't know what is happening in the U.S.

I know it happens in the U.S., but don't know what happens in Lancaster County.

I am aware of current news in Lancaster County regarding human trafficking.

This is all completely new to me.

Other (please explain below)

Have you ever been convicted of a of a crime? (Including a DUI) *

Yes

No

Have you ever been convicted of neglect, abuse, or substance dependency? *

Yes

No

Do you have a physical or emotional condition, including alcohol or drug dependence, which may effect or is likely to effect your ability to perform your professional duties? *

Yes

No

Emergency Contact 1 *

First Name

Last Name

Emergency Contact 1 Phone *

(###)

###

####

Emergency Contact 2 *

First Name

Last Name

Emergency Contact 2 Phone *

(###)

###

####

Reference 1 *

First Name

Last Name

Reference 1 Phone *

(###)

###

####

Reference 2 *

First Name

Last Name

Reference 2 Phone *

(###)

###

####

I understand and affirm that all of the answers provided on my application are true. I understand that misrepresentations or omission of facts called for is cause for dismissal. I hereby authorize North Star Initiative to investigate my background and to contact the above given references for the purposes of determining my suitability as a potential volunteer. *

By clicking this box I agree to the above statement.