Volunteer Form Please enable JavaScript in your browser to complete this form.Personal InformationName *FirstMiddleLastPhoneEmail *Address *Address Line 1City--- Select state ---AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeVolunteer Interests(Select all that apply) *EVENT SUPPORT/PREPACTIVITIES, CLASS, OR EVENTCAMPUS CLEAN-UPHOLIDAYFULFILLING WISHLISTSENCOURAGEMENT CARDSOTHERCriminal HistoryHave you ever been convicted of a felony or misdemeanor in the State of Michigan and/or do you have pending felony charges against you? *YesNoIf you answered yes, please provide (a) the date of the conviction; (b) a description of the facts and circumstances relating to the conviction, including the County where you were convicted; and, if applicable, (c) a description of the pending felony charge, including the County where the charge is pending.Are you listed as a perpetrator of child abuse or neglect on the Central Registry for Abuse and Neglect in the State of Michigan? *YesNoAre you listed as a perpetrator of child abuse or neglect on the Central Registry for Abuse and Neglect in the State of Michigan?Have you ever had a Child Protective Services’ investigation result in a confirmed case of child abuse or neglect against you regardless of whether you were listed on the Central Registry for Abuse and Neglect in the State of Michigan? *YesNoIf you answered yes, please provide (a) the date when the case of abuse or neglect was confirmed against you; and (b) a description of the facts and circumstances relating to the confirmation. (copy)Have you ever been convicted of a felony or identified as a perpetrator of child abuse or neglect in another state? *YesNoIf you answered yes, please provide (a) the date of the felony conviction and/or the date when you were identified as a perpetrator of child abuse or neglect; (b) the state where you were convicted or identified; and (c) a description of the facts and circumstances underlying your conviction or child abuse or neglect identification of conviction relating Applicant Certification and AgreementCarefully read the following statement and sign as specified below. I have completed this application, and hereby declare the information provided is true, complete and correct to the best of my knowledge. I understand that any misstatement or omission of fact on this application will be considered cause for my dismissal. I further authorize Wedgwood Christian Services to obtain references concerning my character, personal qualities, and past job performance. I understand that volunteers are accepted based on program need and best fit for residents’ treatment, and contingent on the status of my background check. Signature Clear Signature DateSubmit