About Us
Programs
- Audio Engineering
- Video Production / Editing
Get Involved
Gallery
- Video Gallery
- Photo Gallery
News & Events
- Upcoming Events
- Press
Contact Us
Donate Now

Volunteer Application

Full Name
Date of Birth
Address

Street Address

Address Line 2

City

State / Province / Region

ZIP / Postal Code

Country
Home Phone
Work Phone
Cell Phone
Best time for us to contact you?
- Morning
- Afternoon
- Evening
Email
Alternative Email
Do you prefer to be contacted by
- Email
- Telephone
Your occupation
Do you work
- Full-time
- Part-time
Name of your employer
Are you currently in school?
- Yes
- No
Identify school name, degree sought, and expected completion/graduation
Highest educational level completed
- Some High School
- High School or GED
- Some College
- Bachelor
- Graduate
- Doctoral
Availability and Interest
- Long-Term (1 year+)
- Short-Term (3 months – 1 year)
- Special Projects/Events Only
Number of hours you are available to volunteer per week
Please identify the days, times, and hours you are available to volunteer
Identify the area(s) you are interested in volunteering (check all that apply)
- Select All
- Audio Instructor
- Video Instructor
- Computer Instructor
- Life-Skills Facilitator
- Administration
- Other
Experience Training and Certifications – please attach a current resume/vitae
Briefly describe your training, certifications, and/or experience that might be useful in this position
References

Please provide the name, telephone number, and relation of three references who can attest to your character.
Name
Phone
Relation
Name
Phone
Relation
Name
Phone
Relation
Background Investigation

The following questions are for pre-screening purposes. A separate Background Investigation Authorization form is required of all
volunteers of Youth Media Minds of America.
Have you ever been convicted of a criminal offense?
- No
- Yes
Have you been convicted of child abuse or sexual abuse or been involved in any activities related to molesting or abusing children/youth?
- No
- Yes
Are you or have you been subject to any court order that involved sexual or physical abuse or a threat of sexual or physical abuse?
- No
- Yes
Has any court refused to award custody, limited visitation or terminated your parental rights because of sexual or physical abuse or its threat?
- No
- Yes
Do you have any charges currently pending against you that involve sexual or physical abuse or threats of sexual or physical abuse?
- No
- Yes
Have you ever resigned or been terminated from a position, paid or unpaid, due to complaints of abuse or sexual harassment against you?
- No
- Yes
I understand that I am not an employee of Youth Media Minds of America and that any duties that I perform are as a volunteer. I certify that all information provided in this application is true and complete. I understand that any false information or omission may disqualify me from serving as a volunteer for Youth Media Minds of America.
Name
Date
Permission to Obtain a Background Check

(“Notice, Authorization and Release for the Procurement of a Consumer and/or Investigative Consumer Report”)

This form authorizes the church to obtain background information and must be completed by the applicant. The church must keep this completed form on file for at least two years after requesting a background check.

I, the undersigned applicant (also known as “consumer”), authorize YOUTH MEDIA MINDS OF AMERICA through its independent contractor, Kroll Background America, Inc. (“KBA”), to procure background information (also known as a “consumer report and/or investigative consumer report”) about me. I understand that this authorization and release is valid for future background information requests during my period of service with YOUTH MEDIA MINDS OF AMERICA for the purpose of investigating any incidents of workplace misconduct or criminal activity for which I am alleged to have been involved during my service. These above-mentioned reports may include my driving history, including any traffic citations; a social security number trace, present and former addresses; criminal and civil history/records; any other public record.

I further authorize any person, business entity or governmental agency that may have relevant information to disclose it to YOUTH MEDIA MINDS OF AMERICA through KBA, including any courts, public agencies, law enforcement agencies and credit bureaus.

I understand that I am entitled to a complete copy of any background information report of which I am the subject upon my written request to KBA, if such is made within a reasonable time from the date it was produced. I also understand that I may receive a written summary of my rights under the Fair Credit Reporting Act and the California Civil Code.
Signature
Date
I would like a copy of the results of this background check
- Yes
- No
Identifying Information for Background Information Agency (also known as “Consumer Reporting Agency”)
Name

First

Middle

Last
Other Names Used (alias, maiden, nickname):
Years Used
Current Address

Street Address

Address Line 2

City

State / Province / Region

ZIP / Postal Code

Country
Former Address

Street Address

Address Line 2

City

State / Province / Region

ZIP / Postal Code

Country
Social Security Number
Daytime Telephone Number
Driver's License Number
State of Issuance
Date of Birth
Gender
- Male
- Female
*This information will enable us to properly identify you in the event we find adverse information during the course of our
background search

This iframe contains the logic required to handle Ajax powered Gravity Forms.

WHO WE ARE

About Us
Get Involved
Events
Press
Contact Us
Donate Now

PROGRAMS

Video Production / Editing
Audio Engineering

Find us elsewhere

Website by easyboyweb.

References

Background Investigation

Permission to Obtain a Background Check

Identifying Information for Background Information Agency (also known as “Consumer Reporting Agency”)