Volunteer

VOLUNTEER AGREEMENT

Thank you for volunteering your services to the needs of the ones we serve. All volunteers must be at least 21 years of age and approved by the leadership of SOCM. Once approved, your name will be added to a list of volunteers. This agreement will expire one year after implementation.

Chaperones

Only approved volunteers can serve as chaperones for outreach sponsored events. Sign up is done online or directly through SOCM office and approved by the leadership on a ”service to service” basis.

In connection with my desire to provide volunteer services to the Souled Out Christian Ministries, SOCM, I consent to and authorize the SOCM and its agent to conduct a criminal history background check. This form does not authorize the SOCM or any agent to perform any type of background check other than a criminal history check. I understand I have the right to review and challenge any negative information that would adversely impact a decision to allow me to volunteer at SOCM. I acknowledge that it is within SOCM’s sole discretion as to whether I am allowed to volunteer services for them.

CONFIDENTIAL

Criminal History Record for Volunteers

All information requested below is necessary to obtain your criminal history record information.

Your First Name
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Middle Name
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Mailing Address
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Zipcode
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City
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  • - select a state -
  • Alabama
  • Alaska
  • Arizona
  • Arkansas
  • California
  • Colorado
  • Connecticut
  • Delaware
  • District of Columbia
  • Florida
  • Georgia
  • Hawaii
  • Idaho
  • Illinois
  • Indiana
  • Iowa
  • Kansas
  • Kentucky
  • Louisiana
  • Maine
  • Montana
  • Nebraska
  • Nevada
  • New Hampshire
  • New Jersey
  • New Mexico
  • New York
  • North Carolina
  • North Dakota
  • Ohio
  • Oklahoma
  • Oregon
  • Maryland
  • Massachusetts
  • Michigan
  • Minnesota
  • Mississippi
  • Missouri
  • Pennsylvania
  • Rhode Island
  • South Carolina
  • South Dakota
  • Tennessee
  • Texas
  • Utah
  • Vermont
  • Virginia
  • Washington
  • West Virginia
  • Wisconsin
  • Wyoming
- select a state -
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Physical Address
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Zipcode
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City
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  • - select a state -
  • Alabama
  • Alaska
  • Arizona
  • Arkansas
  • California
  • Colorado
  • Connecticut
  • Delaware
  • District of Columbia
  • Florida
  • Georgia
  • Hawaii
  • Idaho
  • Illinois
  • Indiana
  • Iowa
  • Kansas
  • Kentucky
  • Louisiana
  • Maine
  • Montana
  • Nebraska
  • Nevada
  • New Hampshire
  • New Jersey
  • New Mexico
  • New York
  • North Carolina
  • North Dakota
  • Ohio
  • Oklahoma
  • Oregon
  • Maryland
  • Massachusetts
  • Michigan
  • Minnesota
  • Mississippi
  • Missouri
  • Pennsylvania
  • Rhode Island
  • South Carolina
  • South Dakota
  • Tennessee
  • Texas
  • Utah
  • Vermont
  • Virginia
  • Washington
  • West Virginia
  • Wisconsin
  • Wyoming
- select a state -
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Gender

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Ethnicity

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Your Last Name
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Date of Birth
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Drivers License Number
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Your Phone Number
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Time Available From
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Suffix Name: Maiden or Other name(s)
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Social Security Number
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Drivers License State
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Your E-mail Address
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Time Available To
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Any Physical Limitations
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Please indicate days available:

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* I understand that the information that I am providing about age, sex, and ethnicity will not be used to determine eligibility for volunteering but will be used solely for the purposes of obtaining criminal history record information.

Please answer the following questions related to your criminal history (if any):

1. Have you ever been convicted or pled guilty before a court for any federal, state or municipal criminal offense? (excluding minor traffic misdemeanors)
If yes, please provide details below.
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  • - State of Conviction-
  • Alabama
  • Alaska
  • Arizona
  • Arkansas
  • California
  • Colorado
  • Connecticut
  • Delaware
  • District of Columbia
  • Florida
  • Georgia
  • Hawaii
  • Idaho
  • Illinois
  • Indiana
  • Iowa
  • Kansas
  • Kentucky
  • Louisiana
  • Maine
  • Montana
  • Nebraska
  • Nevada
  • New Hampshire
  • New Jersey
  • New Mexico
  • New York
  • North Carolina
  • North Dakota
  • Ohio
  • Oklahoma
  • Oregon
  • Maryland
  • Massachusetts
  • Michigan
  • Minnesota
  • Mississippi
  • Missouri
  • Pennsylvania
  • Rhode Island
  • South Carolina
  • South Dakota
  • Tennessee
  • Texas
  • Utah
  • Vermont
  • Virginia
  • Washington
  • West Virginia
  • Wisconsin
  • Wyoming
- State of Conviction-
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County of Conviction
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Date Of Offense
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Details of Conviction:

Details Of Conviction Text
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2. Have you ever received deferred adjudication or similar disposition for any federal, state or municipal offense?
If yes, please provide details below.
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  • - State of Adjudication-
  • Alabama
  • Alaska
  • Arizona
  • Arkansas
  • California
  • Colorado
  • Connecticut
  • Delaware
  • District of Columbia
  • Florida
  • Georgia
  • Hawaii
  • Idaho
  • Illinois
  • Indiana
  • Iowa
  • Kansas
  • Kentucky
  • Louisiana
  • Maine
  • Montana
  • Nebraska
  • Nevada
  • New Hampshire
  • New Jersey
  • New Mexico
  • New York
  • North Carolina
  • North Dakota
  • Ohio
  • Oklahoma
  • Oregon
  • Maryland
  • Massachusetts
  • Michigan
  • Minnesota
  • Mississippi
  • Missouri
  • Pennsylvania
  • Rhode Island
  • South Carolina
  • South Dakota
  • Tennessee
  • Texas
  • Utah
  • Vermont
  • Virginia
  • Washington
  • West Virginia
  • Wisconsin
  • Wyoming
- State of Adjudication-
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County of Adjudication
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Date Of Adjudication
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Details of Adjudication:

Details Of Adjudication Text
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3. Have you ever received probation or community supervision for any federal, state or municipal offense?
If yes, please provide details below.
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  • - State of Supervision-
  • Alabama
  • Alaska
  • Arizona
  • Arkansas
  • California
  • Colorado
  • Connecticut
  • Delaware
  • District of Columbia
  • Florida
  • Georgia
  • Hawaii
  • Idaho
  • Illinois
  • Indiana
  • Iowa
  • Kansas
  • Kentucky
  • Louisiana
  • Maine
  • Montana
  • Nebraska
  • Nevada
  • New Hampshire
  • New Jersey
  • New Mexico
  • New York
  • North Carolina
  • North Dakota
  • Ohio
  • Oklahoma
  • Oregon
  • Maryland
  • Massachusetts
  • Michigan
  • Minnesota
  • Mississippi
  • Missouri
  • Pennsylvania
  • Rhode Island
  • South Carolina
  • South Dakota
  • Tennessee
  • Texas
  • Utah
  • Vermont
  • Virginia
  • Washington
  • West Virginia
  • Wisconsin
  • Wyoming
- State of Supervision-
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County of Supervision
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Date Of Supervision
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Details of Supervision:

Details Of Supervision Text
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4. Have you ever been convicted of any criminal offense in a country outside of the jurisdiction of the United States?
If yes, please provide details below.
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  • - select a Convictions Outside USA -
  • Afghanistan
  • Albania
  • Algeria
  • Andorra
  • Angola
  • Antigua and Barbuda
  • Argentina
  • Armenia
  • Australia
  • Austria
  • Azerbaijan
  • Bahamas
  • Bahrain
  • Bangladesh
  • Barbados
  • Belarus
  • Belgium
  • Belize
  • Benin
  • Bhutan
  • Bolivia (Plurinational State of)
  • Bosnia and Herzegovina
  • Botswana
  • Brazil
  • Brunei Darussalam
  • Bulgaria
  • Burkina Faso
  • Burundi
  • Cabo Verde
  • Cambodia
  • Cameroon
  • Canada
  • Central African Republic
  • Chad
  • Chile
  • China
  • Colombia
  • Comoros
  • Congo
  • Cook Islands
  • Costa Rica
  • Croatia
  • Cuba
  • Cyprus
  • Czechia
  • Côte d\\\'Ivoire
  • Democratic People\\\'s Republic of Korea
  • Democratic Republic of the Congo
  • Denmark
  • Djibouti
  • Dominica
  • Dominican Republic
  • Ecuador
  • Egypt
  • El Salvador
  • Equatorial Guinea
  • Eritrea
  • Estonia
  • Eswatini
  • Ethiopia
  • Faroe Islands
  • Fiji
  • Finland
  • France
  • Gabon
  • Gambia
  • Georgia
  • Germany
  • Ghana
  • Greece
  • Grenada
  • Guatemala
  • Guinea
  • Guinea-Bissau
  • Guyana
  • Haiti
  • Honduras
  • Hungary
  • Iceland
  • India
  • Indonesia
  • Iran (Islamic Republic of)
  • Iraq
  • Ireland
  • Israel
  • Italy
  • Jamaica
  • Japan
  • Jordan
  • Kazakhstan
  • Kenya
  • Kiribati
  • Kuwait
  • Kyrgyzstan
  • Lao People\\\'s Democratic Republic
  • Latvia
  • Lebanon
  • Lesotho
  • Liberia
  • Libya
  • Lithuania
  • Luxembourg
  • Madagascar
  • Malawi
  • Malaysia
  • Maldives
  • Mali
  • Malta
  • Marshall Islands
  • Mauritania
  • Mauritius
  • Mexico
  • Micronesia (Federated States of)
  • Monaco
  • Mongolia
  • Montenegro
  • Morocco
  • Mozambique
  • Myanmar
  • Namibia
  • Nauru
  • Nepal
  • Netherlands
  • New Zealand
  • Nicaragua
  • Niger
  • Nigeria
  • Niue
  • North Macedonia
  • Norway
  • Oman
  • Pakistan
  • Palau
  • Panama
  • Papua New Guinea
  • Paraguay
  • Peru
  • Philippines
  • Poland
  • Portugal
  • Qatar
  • Republic of Korea
  • Republic of Moldova
  • Romania
  • Russian Federation
  • Rwanda
  • Saint Kitts and Nevis
  • Saint Lucia
  • Saint Vincent and the Grenadines
  • Samoa
  • San Marino
  • Sao Tome and Principe
  • Saudi Arabia
  • Senegal
  • Serbia
  • Seychelles
  • Sierra Leone
  • Singapore
  • Slovakia
  • Slovenia
  • Solomon Islands
  • Somalia
  • South Africa
  • South Sudan
  • Spain
  • Sri Lanka
  • Sudan
  • Suriname
  • Sweden
  • Switzerland
  • Syrian Arab Republic
  • Tajikistan
  • Thailand
  • Timor-Leste
  • Togo
  • Tokelau
  • Tonga
  • Trinidad and Tobago
  • Tunisia
  • Turkey
  • Turkmenistan
  • Tuvalu
  • Uganda
  • Ukraine
  • United Arab Emirates
  • United Kingdom of Great Britain and Northern Ireland
  • United Republic of Tanzania
  • United States of America
  • Uruguay
  • Uzbekistan
  • Vanuatu
  • Venezuela (Bolivarian Republic of)
  • Viet Nam
  • Yemen
  • Zambia
  • Zimbabwe
- select a Convictions Outside USA -
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County of Convictions Outside USA
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Date Of Convictions Outside USA
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Details of Convictions Outside USA:

Details Of Convictions Outside USA Text
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5. As of the date of this consent form, do you have any pending charges against you?
If yes, please provide details below.
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  • - State of Pending Charges-
  • Alabama
  • Alaska
  • Arizona
  • Arkansas
  • California
  • Colorado
  • Connecticut
  • Delaware
  • District of Columbia
  • Florida
  • Georgia
  • Hawaii
  • Idaho
  • Illinois
  • Indiana
  • Iowa
  • Kansas
  • Kentucky
  • Louisiana
  • Maine
  • Montana
  • Nebraska
  • Nevada
  • New Hampshire
  • New Jersey
  • New Mexico
  • New York
  • North Carolina
  • North Dakota
  • Ohio
  • Oklahoma
  • Oregon
  • Maryland
  • Massachusetts
  • Michigan
  • Minnesota
  • Mississippi
  • Missouri
  • Pennsylvania
  • Rhode Island
  • South Carolina
  • South Dakota
  • Tennessee
  • Texas
  • Utah
  • Vermont
  • Virginia
  • Washington
  • West Virginia
  • Wisconsin
  • Wyoming
- State of Pending Charges-
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County of Pending Charges
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Date Of Pending Charges
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Details of Pending Charges:

Details Of Pending Charges Text
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List other states of residence:

List other states of residence Text
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In case of emergency, contact:

In case of emergency, contact Full Name
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Emergency Contact Relationship
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Emergency Contact Phone Number
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I certify that all information provided in this form is true, correct, and complete. If it is later shown that any information is incorrect or incomplete, I understand that this would constitute grounds for denying me the opportunity to provide to SOCM voluntary services.

I understand that I am offering my services to SOCM without compensation, and I certify that I am at least 21 years of age.

I understand that all volunteers are expected to conduct themselves in a respectable manner at all times and serve as role models for the ones we serve. I will not use alcoholic beverages, use tobacco products, use or possess controlled substances or dangerous drugs, use inappropriate language, have inappropriate contact with anyone, or otherwise display inappropriate behavior. Volunteers are subject to the same standards of conduct as employees of the SOCM. Proper identification will be worn at all times while on will SOCM during any outreach service.

Interests: Please tell us in which areas you are interested in volunteering

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Printed Name of Volunteer
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Printed Name Required
Date Of Signature
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Date of Signature Required
Upload your Signature...
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