References
References (Please share the name of 3 people you've known at least a year.)
PV-Pals Volunteer Application
Personal Information
Chosen Name
Chosen Name
Pronouns
Legal Name
*
First Name
Last Name
The Pomona Valley Pride is committed to affirming the name and pronouns of our community members and to transparency. For this reason, we feel it is important to share that the background process will require information that includes legal name.
Address
Street Address
Street Address Line 2
City/Zip Code
Please Select
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
Zip Code
Email
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Best Method of Contact
*
Email
Phone Call
Text
Any
What Volunteer Class are you interested in?
*
Tier 1 (court ordered)
Tier 2 (4 or less hrs a month)
Tier 3 (5 or more hrs a month)
Our volunteer programs include bi-weekly meetings (twice a month). These meetings may include, but are not limited to, participating in conversational feedback discussions, sharing experiences, improvements, and debriefing recent events or participation. By the end of the month, volunteers who show up to meetings could participate in a raffle. Is this something you can commit to?
*
Yes
No
Sometimes
Experience
Are you related to or in a relationship with anyone on the staff, board, advisory board, or another volunteer?
*
Yes
No
Do you have experience with children & youth?
*
Yes
No
Do you have a driver's license?
Yes
No
Are you a registered sex offender?
*
Yes
No
Resume (optional)
Browse Files
Drag and drop files here
Choose a file
Cancel
of
Additional skills & knowledge (hobbies, skills, interests)
Certifications & Licenses
Rows
Adult CPR
Infant/Child CPR
Basic First
Aid
EMT/WFA/ WFR
Lifeguard Training/ WSI
LPN/ RN
LMFT/LPCC
Type
Please provide the name, relation to the applicant, and contact information for each reference.
*
Rows
Name
Relation to Reference
Contact Info
Reference 1
Reference 2
Reference 3
Agreements
ALL TIERS OF VOLUNTEERS, please read and select each as an indication that you agree to the following:
*
I agree to abide by the rules and regulations established by Pomona Valley Pride in the interest of the health and welfare of youth, seniors and staff.
I understand that unless PVP has received the satisfactory results of a criminal background screen (conducted with my consent) and I have participated in the minimum training required, I am not authorized to supervise youth, interact with youth without a staff member or board member present. I further understand that at no time is it acceptable for me to be alone with a youth and out of site and beyond hearing distance of a staff person.
PVP sets the highest standards for youth and staff. I understand and agree that I am required to immediately report to the executive director any behavior that does not meet these standards. Unacceptable behaviors include, but are not limited to, sexual activity, drug or alcohol use, emotional concerns/issues, and physical concerns/issues among youth, staff, or between youth and staff. I understand that failure to report these behaviors may constitute personal negligence on my part and result in termination of my service.
I understand that PVP is not responsible for, and therefore does not carry insurance to cover the repair or replacement of personal vehicles or personal property damaged or stolen during the course of my volunteer service, regardless of where and how the damage or theft may have occurred.
In the event that my emergency contact cannot be reached and I am incapacitated, I hereby give permission to the Executive Director to secure treatment for me at the nearest health care facility.
I agree and give consent to PVP to use films, videos, and/or photographs containing me or my likeness for brochures, advertisements, and/or any other publicity purpose.
I further acknowledge and agree that I will adhere to all applicable safety rules, regulations, and provisions while participating in such activities as established by the Pomona Valley Pride. I understand that failure to adhere to these rules, regulations, and provisions may result in immediate termination of my volunteer service with PVP.
Tier 2 & 3: I authorize PVP to thoroughly investigate my educational background, past employment, and personal history that may relate in any way to my volunteer role. I will not hold any official PVP representative liable for giving or receiving information in this investigation.
Tier 2 & 3: I understand and agree that I may be required to take a physical examination and test for illegal drug use as a condition of my volunteer service for the purpose of determining my abilities to perform duties now or in the future. I agree to consent to take such tests at such time as determined by PVP, and I release Pomona Valley Pride and its’ representatives from any claims arising in connection with the use of information resulting from such an examination.
I understand that if I am a minor volunteer, I must have the signed consent of my parent or legal guardian in order to participate in volunteer activities with Pomona Valley Pride (PVP).
I understand that volunteers under the age of 18 are not permitted to serve at 18+ events hosted or supported by PVP.
Acknowledgement
Please read and select each as an indication that you agree and acknowledge the following:
*
I acknowledge that I have read the above and I agree to all the terms listed. I certify that the statements made in this volunteer application are true and correct and have been given voluntarily.
I recognize my right, as a volunteer, to discontinue my service at any time and for any reason. I also understand that Pomona Valley Pride has the right to discontinue my volunteer service relationship.
As a volunteer, I understand and agree that I shall not expect to receive any form of payment, including cash (wages) food, clothing, shelter or other kinds of payment, for volunteer talents and services I contribute to Pomona Valley Pride.
Signature
Language Preference
Please Select
English
Spanish
Submit
Should be Empty: