www.pcarockdale.org
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Latest News

• Free Parenting Programs Starting April 2010 - Click for more info! •

• Rockdale Positive Parenting Program Click for more info! •

• April is child abuse awareness month; pleace click the below link to find out about our upcoming fundraiser Click for more info! •

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Mission Statement: PCA Rockdale exists to prevent child abuse in Rockdale County through awareness, education and collaboration.

Core Values:

  • Prevention of all forms of child abuse
  • Healthy/nurturing environments for children
  • Child-friendly collaborations
  • Resourced child care providers
 
 
Volunteer Application
 

Please fill out this application as completely as possible. As you know, our volunteers may be involved in programs that provide direct services to children. For that reason, please understand that we must screen all of our volunteers thoroughly. Your information will remain confidential and we do not ever share or sell our data.
 

* Fields in bold are required.
Click here if you would like a printable PDF form. Abobe Acrobat Reader required to view file.

First Name
 Middle
 Last Name
Address
City
 State
 Zipcode
Home Phone
 Work Phone
 Mobile Phone
Email Address
Best Time to be Contacted
 Date of Birth

Best Day(s) to volunteer

 Mon Tues Wed Thurs Fri
Sat   Sun
Number of hours available per week
Have you ever been a program participant?  Yes    No   

If “Yes”, which one and when?
Volunteer positions held in the past
Where are you employed?
Fulltime Partime

What skills/talents do you have which might be useful in this program?

What training/experiences do you have which might be useful in this program?
Have you been convicted of a criminal offense?  Yes    No   

If “Yes”, please explain below?

If you have you been convicted of or been involved in any activities related to child abuse, please explain below.
References:
(Please provide name & phone of three references, including a former supervisor)
Name: Number:
Name: Number:
Name: Number:
 

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 further consideration, and may result in my removal if discovered at a later date.  I understand that approval of my application is contingent upon the results of a reference and background review, and I hereby authorize PCAR and its agents to investigate the truthfulness of all information I have provided on my application, resume, and other attachments.  I give consent for all contacted persons to provide information concerning my application, and I release each such person from liability for providing information to PCAR and its agents.  I hereby request and agree that PCAR will respond to inquiries made as a part of a reference check by prospective employers.  I agree to waive any right to bring legal action against PCAR and its agents for the disclosure of such information. 

   
Signature Date


 
 
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