Previous residence if less than 7 years
Please list all members of your household:
Please provide employment information for the past five years, with most recent position held first.
Please answer all the following questions as completely as possible.
Please read the following carefully before signing this application:
I consent to and understand that:
The references and youth serving-organization(s) I listed may be contacted by mail, telephone, email, or in-person;
I am in no way obligated to perform any volunteer services;
Worcester Youth and Family Counseling Services’ Worcester Connects Program is not obligated to match me with a youth and may deny my application or close my match at any time, and to protect all participants’ confidentiality is not required to disclose reasons for doing so;
As part of the enrollment processes, I will be required to provide additional personal information, including completion of an in-person interview;
All applications will be given equal consideration regardless of race, age, sex, disability, marital status, sexual orientation, gender identity, religion or national origin;
By completing this form, you consent to and understand that a background check will be conducted for conviction and pending criminal case information and that it will not necessarily disqualify you from participation;
I understand that the information I provide in the enrollment process will be kept confidential unless disclosure is required by law;
I certify that all information I have provided or will provide to Worcester Youth and Family Counseling Services, including this application, is true, correct, and complete to the best of my knowledge. I certify that I have and will answer all questions to the best of my ability and that I have not and will not withhold any information that would affect my application for a volunteer position. I understand that information contained on my application will be verified by Worcester Youth and Family Counseling Services. I understand that misrepresentations or omissions may be cause for my immediate rejection as an applicant or my termination as a volunteer.
By signing below, I attest to the truthfulness of all information listed on this application and agree to all the above terms and conditions.