PSL Services/STRIVE Volunteer Application

Name
Address

____________________________________________________

Educational Background:

____________________________________________________

Employment:

____________________________________________________

Background Info:

____________________________________________________

Additional Questions:

____________________________________________________

Personal References:

____________________________________________________

Photo Release:

Pictures of volunteer (s)’s activities may be taken and used for publicity purposes including but not limited to publications in commercial periodicals and program newsletters.

initials of volunteer or guardian if under 18

____________________________________________________

Applicant Agreement:

I hereby certify that the facts set forth in and above the volunteer application are true and
complete to the best of my knowledge. I hereby authorize you to make any investigation of any
personal employment history record including the use of investigative agencies or bureaus of
your choice. This report may include information as to your character, general reputation, personal characteristics; criminal and motor vehicle record checks will be performed. I authorize
previous employers, schools which I attended, and character references to provide information
pertaining to my contact with them.
I understand that falsified statements or material omissions on my application shall be considered
sufficient cause for dismissal.