MCOP | Volunteer Application

Volunteer Application

PERSONAL INFORMATION

Name:

Phone:

Address:

Residency:

Income:

Education Info

High School:

College:

Volunteer Position

Position:

Availability:

Volunteer History

Places & Dates:

Duties:

Criminal History Consent Form

As a prospective volunteer of Monroe County Opportunity Program, I understand that it is this organizations policy to secure conviction criminal history information as part of their volunteer screening process using the information provided below.

Name:

Maiden Name:

Other Names:

Birthdate:

Race:

Gender:

I UNDERSTAND THAT THE ABOVE INFORMATION IS REQUIRED BY THE CENTRAL RECORDS DIVISION OF THE MICHIGAN STATE POLICE AND/OR THE OHIO STATE POLICE DEPARTMENTS. I FURTHER UNDERSTAND THAT A CONVICTION RECORD DOES NOT NECESSARILY PREVENT EMPLOYMENT. I AUTHORIZE MONROE COUNTY OPPORTUNITY PROGRAM TO UTILIZE THE ABOVE INFORMATION FOR THE SOLE PURPOSE OF OBTAINING INFORMATION REGARDING A CRIMINAL CONVICTION.

Signature:

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