Girl Scouts of Connecticut: Application for Volunteer Service

APPLICATION FOR VOLUNTEER SERVICE

Girl Scouting maintains that the strength of the organization rests in the voluntary leadership of its adult members. In appointing volunteers to Girl Scout volunteer positions, it is important that the qualifications of the position match the skills, interests, and time availability of the volunteers. Information provided will be maintained in a confidential manner.
Please complete the following information: (note, fields marked * are required)

Basic Information
M.I. First Name*	Last Name*
Daughter's Name(s) (if applicable)
Address*
City* State* Zip*
If not at this address for more than two years, please give prior address(es).
E-mail address*
Town Where Interested in Volunteering*	Troop/Group No.
Home/Cell Phone*	Work/Alternate Phone
Please indicate other names and nicknames that you have used that may be necessary for us to verify the information on this application.
List other Girl Scout Councils with which you have been involved.
Volunteer Position Sought

Employment Information
Please provide accurate and complete information for your current or last employment (including temporary, part-time, self-employment, or unemployment).
Employer's Name	Start Date	End Date
Address
Position(s	Reason for Leaving	Supervisor's Name
Phone Number with Area Code:

References
You must list three (3) persons (non-relatives) who are familiar with your qualifications for Girl Scout service.
Reference 1
Name*
Address*
City*	State*	Zip*
Email*	Day Phone*	Evening Phone*

Reference 2
Name*
Address*
City*	State*	Zip*
Email*	Day Phone*	Evening Phone*

Reference 3
Name*
Address*
City*	State*	Zip*
Email*	Day Phone*	Evening Phone*

Volunteer Experience
(List previous Girl Scout or other youth service first.) Please provide accurate and complete information for all volunteer experience for the last ten years.
Organization 1
Organization's Name	Start Date	End Date
Address
Positions	Responsibilities	Supervisor's Name
Email Address	Phone Number

Organization 2
Organization's Name	Start Date	End Date
Address
Positions	Responsibilities	Supervisor's Name
Email Address	Phone Number

Organization 3
Organization's Name	Start Date	End Date
Address
Positions	Responsibilities	Supervisor's Name
Email Address	Phone Number

Additional Information
Hobbies, skills, training, and educational background - Please describe.
Vehicle Use - Please provide the following information so you may transport participants in a Girl Scout activity or in an emergency.
Driver's License Number	State	Type
Insurance Carrier	Policy Number	Expiration Date

This is an application for a volunteer position in Girl Scouting for which there is no monetary compensation.

In the selection of volunteers, there shall be no discrimination against any person on the basis of race, religion, color, sex, age, national origin or ancestry, citizenship, disability, sexual orientation, marital status, or veteran status.

I hereby authorize you to check all my references. I further authorize these references to release to you any and all information that they have about me, and I release all parties involved from any liability arising out of the release of that information.

I understand that criminal background searches/checks are required by Girl Scouts of Connecticut, and I understand that these searches/checks may also be conducted on other individuals in my household.

I acknowledge that I have received a copy of the Background Search Policy and Procedures for Employees and Volunteers, as well as a copy of the Authorization and Consent for Release of Information for Background Search form.

I understand, for my application to be considered, that I must complete the Authorization and Consent for Release of Information for Background Search form.

I understand that if appointed to a volunteer position, I will be required to comply with Girl Scouts of the USA and Girl Scouts of Connecticut policies and standards; will register with the Girl Scouts of the USA; and will fulfill my responsibilities to the best of my ability.

I understand that any misrepresentation, omission, or falsification of any fact from this application or during any interview will be cause for rejection of this application or dismissal from volunteer services. I also understand that acceptance for volunteer service is subject to verification of references.

I have read and agree to the terms outlined above and wish to submit my application to become a volunteer.

APPLICATION FOR VOLUNTEER SERVICE

Reference 1

Reference 2

Reference 3

Organization 1

Organization 2

Organization 3