Kansas Children's Service League
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Volunteer Opportunity Location
Today's Date Name
Address City State Zip
Home Phone Cell Are you 18 years of age or older?
Current Employer Current Position
Work Phone May we contact you at work?
How did you learn about KCSL?
What other volunteer opportunities interest you?
Previous Volunteer Experience
Skills and Experience that would be applicable to your volunteer job
What are your reasons for volunteering?
What length of time are you looking to volunteer for the Agency?
Have you been convicted of a crime? Please Explain:
In case of an emergency, whom may we contact?
Name Relationship Phone
Physician Phone Preferred Hospital
Please list for references (please, no relatives), Complete ALL information requested. Please type or print.
Name Address City State Zip Phone
By typing my signature below, I acknowledge that the above information is true and complete to the best of my knowledge. It also authorizes KCSL to contact my references, and any other person or agency named in this application. I understand that I cannot volunteer at Kansas Children's Service League in direct service to children and families, if I have a felony record, a validated case of child abuse, or have had a child removed due to child abuse or neglect. I further state that none of the above conditions apply. I am willing to submit my name for the security clearance necessary for employment (DCF Child Abuse Registry and/or KBI check.)
Signature Date
Any contributions to the cost of performing required background screens are appreciated.
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