Nehemiah's Workshop Volunteer Application Form

Nehemiah's Workshop, CHAT's woodworking program, equips youth and young adults with woodworking skills to build self esteem and long-term vocational success. The ideal volunteer is an individual that works well with others from a diverse background. The candidate must enjoy working with youth, be able to adapt easily, and have good communication and interpersonal skills. Our volunteer opportunities vary from Weekday afternoons to Saturday Mornings.

Nehemiah's Workshop Programs Include:
Basic Woodworking Life Skills Class (For elementary and middle school youth) - Volunteers Needed
Entrepreneurship Program (For teens)
YALP (Young Adult Leadership Program) (For young adults post high school)
School Elective Class (for teens)

If you have any questions about volunteering in our workshop please contact Steve Trivett at steve.trivett@chatrichmond.org.

Name *

Name

First Name

Last Name

Email Address *

Gender *

Occupation and/or School Name *

How did you hear about CHAT?

Which Day/s of the week would you like to volunteer? *

Weekday Afternoons

Saturday Mornings

Volunteer Background Check

This form authorizes CHAT to obtain background information and must be completed by the applicant. CHAT must keep this completed form on file for at least five years after requesting a background check. In the interest of safety and security I, the undersigned applicant (also known as "consumer"), authorize Church Hill Activities and Tutoring through its independent contractor, LexisNexis, to procure background information (also known as a "consumer report and/or investigative consumer report") about me, prior to, and at any time during, my service to the organization. This report may include my driving history, including any traffic citations; a social security number verification; present and former addresses; criminal and civil history/records; and the state sex offender records. I understand that I am entitled to a complete copy of any background information report of which I am the subject upon my request to Church Hill Activities and Tutoring, 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. *

Have you ever been convicted of a criminal offense (felony or misdemeanor, except for minor traffic violations such as non-reckless speeding tickets) *

Yes

Has your conduct with children, youth or adults ever been cause for investigation, arrest, or any other legal proceeding by a social services agency, child abuse registry, or law enforcement authority? *

Yes

Has your personal or professional interaction with children ever led to disciplinary action by an employer, church, or other organization? *

Yes

If you answered yes to any of these questions please explain (or as mentioned above you may discuss these matters with a CHAT staff member for the area in which you would serve)

Permission to Obtain a Background Check

This form must be completed by each applicant who wishes to serve with children/youth at CHAT as a volunteer leader or staff member. All information is treated as confidential. After evaluation, your records will be kept in a secured file drawer under the control of CHAT's Operation Director. Cost: It costs CHAT $9 to run each background check. CHAT is a 501c3 funded primarily through the generous donations from individuals throughout the community and beyond. If you are able to make a donation to help cover the cost of the background check it would be greatly appreciated. Short Answer Questions: Please answer the following questions. (If you prefer, you may discuss these matters with a CHAT staff member responsible for the area in which you propose to serve.) *

Today's Date

YYYY

Identifying Information for Background Information Agency (also known as "Consumer Reporting Agency") *

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

First Name

Last Name

Spouse Name (If Applicable)

First Name

Last Name

Other names used (maiden, nickname etc.)

Gender *

Address *

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Dates of residence at current address *

Social Security Number: Necessary to complete background check. If you prefer, you may call the Volunteer Coordinator to communicate your social security number for your background check.

Daytime Phone Number

(###)

###

####

Driver's License Number

Date of Birth *

Date of Birth

YYYY