Volunteer Application

Education
[If yes, please explain the nature of the crime and the date of the conviction and disposition.] Conviction of a crime is not an automatic disqualification for volunteer work.
References
REFERENCES: Please list three people who know you well and can attest to your character, skills and dependability. Include your current or last employer.
Name/Organization, relationship to you, phone number, & length of relationship.
Name/Organization, relationship to you, phone number, & length of relationship.
Name/Organization, relationship to you, phone number, & length of relationship.
PLEASE READ THE FOLLOWING CAREFULLY BEFORE SUBMITTING THIS APPLICATION:
By submitting this form online, I understand that this is an application for and not a commitment or promise of volunteer opportunity. I certify that I have and will provide information throughout the selection process, including on this application for a volunteer position and in interviews with Ford-Iroquois Public Health Department that is true, correct and complete to the best of my knowledge. I certify that I have and will answer all questions to the best of my ability and that I have not and will not withhold any information that would unfavorably affect my application for a volunteer position. I understand that a background check and the ESAR-VIP (commonly referred to as CreditSmart) will be completed and verified by the Ford-Iroquois Public Health Department. I understand that misrepresentations or omissions may be cause for my immediate rejection as an applicant for a volunteer position with the Ford-Iroquois Public Health Department or my termination as a volunteer.
Legal basis is located in Federal 16 U.S.C. 742f(c) and 29 CFR 553.10
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