Personal Information
Previous residence if less than 7 years
Employment History
Please provide employment information for the past five years, with most recent position held first.
Dates of Employment*
Dates of Employment*
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.