VOLUNTEER APPLICATION for the Bluebonnet Children's Advocacy Center
All information gathered in this application will be used for the sole purpose of evaluating the individual
for a volunteer position with the Bluebonnet Children’s Advocacy Center. The applicant understands
that a criminal background check will be completed in order to ensure the safety of the applicant, staff,
and clients of the Bluebonnet CAC. ________ (initial)
SECTION I – BIOGRAPHICAL INFORMATION
FULL NAME: __________________________________________________________
FIRST MIDDLE LAST
MAILING ADDRESS: ___________________________________________________
STREET CITY ZIP CODE
HOME PHONE: ______________________ ALT. PHONE: ______________________
BIRTHDATE: _______________________
SECTION II – EXPERIENCE AND AVAILABILITY
EDUCATIONAL HISTORY
HIGHEST LEVEL OF EDUCATION COMPLETED: __________ ___________________
CURRENT EDUCATIONAL INVOLVEMENT: _______________________ ________
WORK/VOLUNTEER HISTORY
CURRENT EMPLOYMENT: ________________________________________ _________
CURRENT WORK SCHEDULE: _________________________________________ ____
CURRENT VOLUNTEER PLACEMENT: ___________________________ ____________
CURRENT VOLUNTEER SCHEDULE: __________________________ _
PREVIOUS VOLUNTEER
EXPERIENCE
VOLUNTEER AVAILABILITY (CHECK THE DATES AND TIMES THAT YOU ARE AVAILABLE TO
VOLUNTEER):
___MON ___TUES ___WEDS ___THURS ___FRI ___SAT
___ANYTIME ___ANYTIME ___ANYTIME ___ANYTIME ___ANYTIME ___ANYTIME
___9-NOON ___9-NOON ___9-NOON ___9-NOON ___9-NOON ___9-NOON
___1-4PM ___1-4PM ___1-4PM ___1-4PM ___1-4PM ___1-4PM
PAGE 2
THE BLUEBONNET CAC OFFERS VOLUNTEERS A VARIETY OF AREAS IN WHICH THEY CAN
EXPRESS THEIR STRENGTHS. PLEASE CHECK ALL AREAS IN WHICH YOU WOULD BE INTERESTED
IN VOLUNTEERING YOUR TIME.
___DIRECT SERVICE VOLUNTEER – WORK ONE ON ONE WITH THE FAMILIES AND CHILDREN WHEN
THEY ARE WAITING TO BE SEEN AT THE CENTER (GREETING, OFFER DRINKS, PLAY WITH
CHILDREN IN PLAY ROOM, ETC)
___CLERICAL ASSISTANT VOLUNTEER – ASSIST STAFF WITH OFFICE DUTIES (ANSWER PHONES,
GREET CLIENTS, MAKE COPIES, ETC)
___FUNDRAISING VOLUNTEER – WORK WITH THE STAFF AND BOARD OF DIRECTORS TO
ORGANIZE AND HOLD FUNDRAISERS FOR THE CENTER
SECTION III – THE NEXT SECTION OF THE APPLICATION INCLUDES QUESTIONS THAT ARE VITAL TO
YOUR PERFORMANCE AS A VOLUNTEER IN A HIGHLY SENSITIVE ENVIRONMENT. PLEASE ANSWER
THEM HONESTLY, AND REMEMBER YOUR RESPONSES WILL REMAIN CONFIDENTIAL.
DESCRIBE YOURSELF
___________________________________________________________________________________
___________________________________________________________
WHY DO YOU WANT TO BE A VOLUNTEER AT BLUEBONNET CAC?
_____________________________________________________________ __________
WHAT EXPERIENCE DO YOU HAVE WITH CHILDREN?
___________________________________________________________________________________
______________________________ ____________ _____
WHAT EXPERIENCE DO YOU HAVE WITH CHILD ABUSE?
HOW DO YOU PROCESS STRESSFUL SITUATIONS?
___________________________________________________________________________________
___________________________________________________________________________________
____________________________________________________________________
WHAT WOULD YOU DO IF A CHILD GAVE YOU INFORMATION ABOUT HIS/HER ABUSE WHILE YOU
WERE VOLUNTEERING AT THE CENTER?
___________________________________________________________________________________
_____________________________________________________________
PAGE 3
AUTHORIZATION TO RELEASE INFORMATION
THE BLUEBONNET CAC WILL COMPLETE A CRIMINAL RECORD CHECK WITH LAW ENFORCEMENT
AND CHILD PROTECTIVE SERVICES ON ALL VOLUNTEERS, BOARD MEMBERS, AND STAFF. THIS IS
DONE TO ENSURE THE SAFETY OF THE VOLUNTEER, BOARD MEMBER, AND STAFF MEMBER AS
WELL AS THE CHILDREN AND FAMILIES WE SERVE.
THE BLUEBONNET CAC DOES NOT ACCEPT APPLICANTS FOR ANY POSITION IF THEY HAVE BEEN
CONVICTED, HAVE PRIOR CHARGES, OR HAVE CHARGES PENDING FOR A FELONY OR
MISDEMEANOR INVOLVING A SEX OFFENSE, VIOLENT ACT, CHILD ABUSE OR NEGLECT, OR
RELATED ACTS THAT WOULD POSE A RISK TO THE CHILDREN SEEN AT THE CENTER OR TO THE
CAC PROGRAM’S CREDIBILITY.
I, ________________________________, HEREBY AUTHORIZE THE BLUEBONNET CAC TO USE
INFORMATION GATHERED IN THIS APPLICATION IN ORDER TO HAVE A CRIMINAL BACKGROUND
CHECK COMPLETED BY LAW ENFORCEMENT AND CHILD PROTECTIVE SERVICES AND I
AUTHORIZE THOSE AGENCIES TO RELEASE INFORMATION REGARDING MY CRIMINAL HISTORY TO
THE BLUEBONNET CAC. THIS INCLUDES BUT IS NOT LIMITED TO ARREST RECORDS AND
CONVICTION DATA.
I HEREBY RELEASE LAW ENFORCEMENT AND CHILD PROTECTIVE SERVICES, AS CUSTODIANS OF
SUCH RECORDS, INCLUDING ALL OFFICERS, EMPLOYEES OR RELATED PERSONNEL, BOTH
INDIVIDUALLY AND COLLECTIVELY, FROM ANY LIABILITY OR FOR DAMAGES OF ANY TYPE WHICH
MAY AT ANY TIME RESULT TO ME, MY HEIRS, FAMILY OR ASSOCIATES BECAUSE OF COMPLIANCE
WITH THIS AUTHORIZATION.
__________________________________________ _____________________________
SIGNATURE DATE
PAGE 4
(AUTHORIZATION TO RELEASE INFORMATION CONTINUED)
IN ORDER TO COMPLETE THE BACKGROUND CHECK, THE FOLLOWING INFORMATION IS NEEDED:
FIRST NAME MIDDLE NAME LAST NAME
OTHER NAMES (MAIDEN, ETC.) _______________________________________________
___________________________________________ _____________________________
SIGNATURE DATE
HAVE YOU LIVED OUTSIDE TEXAS IN THE LAST 3 YEARS? ____________
IF YES, WHERE AND WHEN:
______________________________________________________________________________
SOCIAL SECURITY #: __________________________________________
DRIVERS LICENSE #: ___________________________________________
DOB: ________________________ PLACE OF BIRTH: _______________________
GENDER: _____________ ETHNICITY: ________________________
HEIGHT: ____________ WEIGHT: ___________
EYE COLOR: ______________ HAIR COLOR: ____________________
Please Mail when finished to:
Bluebonnet Children's Center
PO Box 208
Uvalde, TX 78802