What positions are you interested in? *

Mentor

Substitute Mentor

Crew Leader

Station Leader

Unplugged Mentor/Coach (Currently Unavailable)

On-Site Assistant

Driver

Other

Name *

First Name

Last Name

Previous/Maiden Name

First Name

Last Name

Birthdate *

MM

DD

YYYY

Phone *

(###)

###

####

Secondary Phone

(###)

###

####

Current Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Non-Driver Agreement *

I agree not to transport any youth in any vehicle as part of the Whiz Kids program unless I have completed the driver screening process (including the Driver agreement) and been informed by my supervisor that I have been cleared to drive. I also agree not to drive any youth unless another screened adult is present at all times.

Yes, by checking this box, I agree that under no circumstances will I transport any children involved in the Whiz Kids organization or affiliated organizations without driver screening, clearance, and explicit permission from my supervisor.

Arrest/Conviction Record *

Whiz Kids checks arrest and conviction records for all volunteers. A record does *not* automatically mean you will not be offered a position as a volunteer. The circumstances surrounding the incident and how long ago the incident occurred are important considerations in determining your eligibility. Have you ever been arrested for or convicted of any criminal offense (other than a minor traffic violation)?

No

Yes

Crime or Accusation of Crimes Against Children *

Have you ever committed or been accused, charged, or alleged to have committed any act of neglecting, abusing or molesting any children?

No

Yes

Background Check Authorization: *

In conjunction with my application to volunteer for Whiz Kids, I understand that you intend to perform a background check to obtain Consumer Reports and / or Investigative Consumer Reports (hereinafter called "Reports") about me as defined in the Fair Credit Reporting Act (FCRA). Whiz Kids completes a background check on all volunteer applicants who will be working with youth. The background check reviews national and local criminal files and national sexual offender files only, as well as Bureau of Motor Vehicles if a driver check is required. WE DO NOT RUN A CREDIT CHECK OF ANY KIND. I understand that you may rely on any or all of the above referenced information in determining whether to extend an offer allowing me to volunteer. If you contemplate making an adverse volunteer-related decision that will affect me based, in whole or in part, upon a "Report", I will be provided with a copy of the "Report" and a written summary of my Consumer Rights under the FCRA before you finalize that decision. I have read the above disclosure and I hereby authorize you, or authorized agents to obtain the above referenced information about me. I also authorize all agencies, bureaus, employers, information service organizations and individuals to provide any of the above referenced knowledge or information they have concerning me. If I am approved to volunteer, this authorization shall remain on file and shall serve as an ongoing authorization for you to obtain "Reports" about me from authorized agents at any time during my volunteer service with you.

Yes, I agree to be subjected to a background check for criminal records as per the aforementioned terms.

Applicant's Statement: *

The information in this application is correct to the best of my knowledge. I authorize any References listed in this application to provide any staff associated with Whiz Kids (whether paid or volunteer) with any information regarding my character and fitness for work with minor children. I release all such References from any liability for furnishing such information to any staff associated with Whiz Kids (whether paid or volunteer) and I waive any right that I may have to inspect any written statements provided to any records memorializing conversations any staff of Whiz Kids (whether paid or volunteer) may have with such references. I authorize Whiz Kids to share any information that I have provided, any information obtained from the References I have listed, and any information obtrained through a criminal background, motor vehicle check or other appropriate investigation with any staff of Whiz Kids (whether paid or volunteer) when necessary to evaluate my acceptance or continuation as a volunteer in the Whiz Kids program. I understand that background checks will be conducted periodically, and that it is my responsibility to report any changes to my criminal history. I authorize Whiz Kids and its partnering churches to use my name, photograph, and/or video material in its promotional materials. By checking the box below, and submitting the completed application, I am stating my agreement with the above.

Yes, I agree to the terms and conditions presented above.

FBI/CBI Background Check *

All volunteers will have to submit to an FBI/CBI background check, including fingerprints. The arrangements for the fingerprinting will be made for you, or you will be given instructions as to where to have the fingerprinting done. There is no cost to you for this service.

Yes, I agree to submit to a background check in FBI/CBI databases, and understand that I will need to provide fingerprints to relevant agencies