Please fill out the application completely.Step 1 of 90%Identity InformationInformation collected is required for the purposes of identification and is confidential. Name:(Required)Please add your full legal name. First Middle Last Suffix Name you go by: First Have you ever used any other names?(Required) Yes NoMaiden or Other Names Used:(Required)Date of Birth(Required) MM slash DD slash YYYY Identity VerificationDriver's License Number:(Required)State that Issued Driver's License:(Required)AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces PacificHome Address:(Required) Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code How long at current Address?(Required)Less than 5 years6-10 years11-15 yearsMore than 15 yearsFormer Address 1:(Required) Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code How long at former Address 1?(Required)Less than 5 years6-10 years11-15 yearsMore than 15 yearsFormer Address 2:(Required) Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code How long at former Address 2?(Required)Less than 5 years6-10 years11-15 yearsMore than 15 yearsContact InformationEmail(Required) Preferred Method of Phone Contact:(Required) Home Cell WorkBest time to call:(Required) HH: MM AMPM AM/PMHome Phone:(Required)Cell Phone:(Required)Work Phone:(Required)Skills and EducationEmployer:(Required)Occupation:(Required)Previous Work Experience (Including Volunteer Work):(Required)Education:(Required)Please list name and location of school, degree or diploma, and graduation date.Personal NeedsDo you have any health limitations?(Required) No YesPlease Explain:(Required)Emergency Contact Number:(Required)Interests and PlacementHow did you hear about Aaron's Staff?(Required)Are you CPR Certified?(Required) Yes NoAre you willing to become certified?(Required) Yes NoDo you know sign language?(Required) Yes No OtherMost Aaron’s Staff Volunteers are direct caregivers for children, but there are behind the scenes tasks where volunteers provide valuable service. Please indicate ALL the areas in which you would be willing to help. Checking these will not obligate you to any task.(Required) I am only interested in one-on-one caregiving Parent hospitality New volunteer orientation Crafts Coordinator Music Coordinator Kitchen Help/Snacks Monitoring Hallways OtherWhere else could you help?(Required)The following area helps us to match you more appropriately with the children who receive care from Aaron’s Staff. I am comfortable with children who are (check as many as apply)(Required) Medically fragile Uncommunicative Emotionally challenged Hyperactive/Attention Deficit Disorder Infants (2 months-1 year) Children (1-12) TeensPersonal HistoryHave you ever been convicted of or pled guilty to either a misdemeanor or a felony; including but not limited to – drug-related convictions, child abuse, other crimes of violence, theft or motor vehicle violations?(Required) Yes NoFully Explain:(Required)ReferencesReferences: Please list two personal references (people who are not related to you by blood or marriage) and provide the contact information for each. References are confidential.Reference 1 Name:(Required) First Last How do you know Reference 1?(Required)Address of Reference 1:(Required) Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Reference 1 Home Phone:(Required)Reference 1 Cell Phone:(Required)Reference 1 Work Phone:(Required)Reference 2 Name:(Required) First Last How do you know Reference 2?(Required)Address of Reference 2:(Required) Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Reference 2 Home Phone:(Required)Reference 2 Cell Phone:(Required)Reference 2 Work Phone:(Required)Waiver and ConsentPlease read and check that you understand and agree to the following...I authorize(Required) the references listed above to provide whatever information they may have regarding my character and fitness for working with Aaron’s Staff and waive any rights I may have to confidentiality.I consent to(Required) Aaron’s Staff and/or its agents to make an independent investigation of my background, references, character, criminal or police records, including those maintained by both public and private organizations and all public records for the purpose of confirming the information contained on my application and/or obtaining other information which may be material to my qualification for becoming a volunteer.I release(Required) Aaron’s Staff and/or its agents and any person or entity which provides information pursuant to this authorization from any and all liabilities, claims or law suits in regards to the information obtained from any and all of the above referenced sources usedI certify(Required) the name I have provided on this application is my true and complete legal name and all information is true and correct to the best of my knowledge.I have(Required) read this waver and application and am aware of its contents.I sign(Required) this consent freely and under no duress or coercion.
