Navigate Recovery Gwinnett Volunteer Application First Name * Last Name * Phone * Email Address 1 Address 2 City State ALABAMA ALASKA ARIZONA ARKANSAS CALIFORNIA COLORADO CONNECTICUT DELAWARE DISTRICT OF COLUMBIA FLORIDA GEORGIA HAWAII IDAHO ILLINOIS INDIANA IOWA KANSAS KENTUCKY LOUISIANA MAINE MARYLAND MASSACHUSETTS MICHIGAN MINNESOTA MISSISSIPPI MISSOURI MONTANA NEBRASKA NEVADA NEW HAMPSHIRE NEW JERSEY NEW MEXICO NEW YORK NORTH CAROLINA NORTH DAKOTA OHIO OKLAHOMA OREGON PENNSYLVANIA RHODE ISLAND SOUTH CAROLINA SOUTH DAKOTA TENNESSEE TEXAS UTAH VERMONT VIRGINIA WASHINGTON WEST VIRGINIA WISCONSIN WYOMING AMERICAN SAMOA FEDERATED STATES OF MICRONESIA GUAM MARSHALL ISLANDS NORTHERN MARIANA ISLANDS PALAU PUERTO RICO U.S. MINOR OUTLYING ISLANDS VIRGIN ISLANDS ARMED FORCES AMERICAS ARMED FORCES ARMED FORCES PACIFIC ALBERTA BRITISH COLUMBIA MANITOBA NEW BRUNSWICK NEWFOUNDLAND AND LABRADOR NOVA SCOTIA NORTHWEST TERR. NUNAVUT ONTARIO PRINCE EDWARD ISLAND QUEBEC SASKATCHEWAN YUKON Zip Company Name Special Training, skills, hobbies Groups, clubs,organizational memberships Please describe your prior volunteer experience What experiences have you had that may prepare you to work as a volunteer in the field of addiction recovery services? Why do you want to volunteer? (what do you want to gain from this volunteer experience?) Have you ever been convicted of a crime? (If yes, please explain the nature of the crime and the date of conveiction and disposition) Conviction of a crime is not an automatic disqulification for volunteer work. Navigate Recovery has a rich volunteer culture and we depend on your help to change the way we treat addiction in our community. We believe in your contribution to the team and put our volunteers in positions of trust. You have access to people, places and things that most people don’t. Requiring volunteers to provide the information above is one more way we can ensure a safe environment for all adults and children who come through our doors. Do you have a driver's license? Yes No Do you have car insurance? Yes No Do you have a car available for transporting others? Yes No Please list three people who know you well and can attest to your character, skills, and dependability. (Be sure to include phone numbers) Please read the following carefully before submitting this application: I understand that this is an application for and not a commitment or promise of volunteer opportunity. I certify that I have and will provide information throughout the selection process, including on this application for a volunteer position and in interviews with Navigate Recovery Gwinnett that is true, correct and complete to the best of my knowledge. I certify that I have and will answer all questions to the best of my ability and that I have not and will not withhold any information that would unfavorably affect my application for a volunteer position. I understand that information contained on my application will be verified by Navigate Recovery Gwinnett. I understand that misrepresentations or omissions may be cause for my immediate rejection as an applicant for a volunteer position with Navigate Recovery Gwinnett or my termination as a volunteer. Please write down the days and times your are able to volunteer
