EmailMe Form - CACM Volunteer Application

Name *

First Last

Birthday *

Phone *

### - ### - ####

Email

Address *

Street Address City State / Province / Region Postal / Zip Code

What days or times would you be available to volunteer? *

Do you have any physical limitations? *

Yes

No

If yes, please describe:

Have you been convicted of a felony in the last seven years? *

Yes

No

Reference *

First Last

Reference Phone *

### - ### - ####

Reference

First Last

Phone

### - ### - ####

Clearance Requirements:

Effective July 1, 2015, state law requires all volunteers who have direct contact with children to obtain a report of criminal history from the Pennsylvania State Police and a child abuse history clearance from the Pennsylvania Department of Human Services. Connellsville Area Community Ministries (CACM) supports a variety of programs that engage people of all ages. Therefore, all of the volunteers at CACM need to complete all clearances, as required by the law. All new volunteers must obtain all necessary clearances before they can begin their volunteer service.
Please go to www.keepkidssafe.pa.gov for more information, as well as links to complete your clearances.

I have up-to-date Child Abuse Clearance and PA State Police Backgound Check certificates: *

Yes

No