Application for Adult Volunteer Position Survey

Thank you for your interest in volunteering with Girl Scouts of Citrus Council. By providing the following information, you are completing the Volunteer Application/Consent Form for adult volunteers.

This is PART-1 of your Girl Scouts of Citrus Council's official application to be a volunteer.

PART-2 is your confidential information provided to IntelliCorp for your criminal background screening.

After completing PART-1, you will be redirected to Intellicorp's website, there you will complete PART-2 by providing the information necessary to complete the process.

1. Please enter your birth date.

	MM		DD		YYYY
Date	Please enter your birth date. Date Month	/	Day	/	Year

2. Please provide the necessary information about yourself.

Please provide the necessary information about yourself. First Name:
Middle Name:
Last Name:
Address:
City/Town:
State:
ZIP/Postal Code:
County (Orange, Osceola, Seminole, Lake, Brevard, Volusia, etc.)
Email Address:
Phone Number (xxx-xxx-xxxx):

3. Please select one:

Please select one: I am a current volunteer and need to update my information and background check (continue to Question 4 - skip Questions 5 & 6).

I want to become a NEW volunteer with Girl Scouts of Citrus (skip Question 4).

4. I am currently a:

I am currently a: Leader/Assistant Leader/Co-Leader

Parent/Guardian already volunteering

Council Volunteer

Other (please specify)

5. I would like to become a:

I would like to become a: New Leader/Assistant Leader/Co-Leader

Parent/Guardian Volunteer

Council Volunteer

Other (please specify)

6. What type of volunteer service interests you?

What type of volunteer service interests you? Working directly with girls Working with adult committees Being a mentor to one of more girls	Program activities Training and teaching adults Fund development with special events	Assisting public relations with media Helping with occasional office work Outdoor activities
Other (please specify)

7. Current Employment

Current Employment Position
Employer
Address

8. Please tell us about your previous volunteer experience.

Please tell us about your previous volunteer experience. Organization Name
Position
Organization Name
Position

Girl Scouts of Citrus Council serves girls in Brevard, Lake, Orange, Osceola, Seminole and Volusia counties.

9. If you are volunteering in a certain geographical area, please enter that information below.


Service Unit (if known):	If you are volunteering in a certain geographical area, please enter that information below. Service Unit (if known):

10. Troop Number (if known):

Troop Number (if known):

11. Nearest School:

Nearest School:

12. Is there any other information you would like to add?

Is there any other information you would like to add?

Girl Scouts of Citrus Council is dedicated to the safety of the girls and adults in our membership. It is mandatory to complete the following questions. Failure to complete these questions and the background criminal screening will disqualify your application.

13. Have you ever been convicted of a crime - either a misdemeanor or a felony including DUI, but not including minor traffic violation or any convictions as a youth offender?

Have you ever been convicted of a crime - either a misdemeanor or a felony including DUI, but not including minor traffic violation or any convictions as a youth offender? Yes

If yes, please explain:

14. Have you ever pled nolo contendere, served a term of probation or entered a pre-trial diversion program in connection with being charged with a crime other than a minor traffic violation?

Have you ever pled nolo contendere, served a term of probation or entered a pre-trial diversion program in connection with being charged with a crime other than a minor traffic violation? Yes

If yes, please explain:

15. Have you ever been convicted or plead guilty before a court of any federal, state, or municipal criminal offense? (excluding minor traffic violations)

Have you ever been convicted or plead guilty before a court of any federal, state, or municipal criminal offense? (excluding minor traffic violations) Yes

If yes, please explain:

16. Have you ever been accused of molesting or abusing a minor?

Have you ever been accused of molesting or abusing a minor? Yes

If yes, please explain

17. Have you ever been convicted of any criminal offense in a country outside the jurisdiction of the United States?

Have you ever been convicted of any criminal offense in a country outside the jurisdiction of the United States? Yes

If yes, please explain:

18. As of the date of this authorization, do you have any pending criminal charges against you?

As of the date of this authorization, do you have any pending criminal charges against you? Yes

If yes, please explain:

19. This Section is to be used to list all COUNTIES and STATES of residence for the last 10 years. Please be as specific about dates of residence as possible. Include:

City or Town/State/Dates From Date To
(ex: Orlando/Florida/1998-2005)

This Section is to be used to list all COUNTIES and STATES of residence for the last 10 years. Please be as specific about dates of residence as possible. Include: City or Town/State/Dates From Date To (ex: Orlando/Florida/1998-2005)

This is an application for a volunteer position in Girl Scouting for which there is no monetary compensation.

By submitting your application you agree:

I understand that criminal background screenings are required by Girl Scouts of Citrus Council. I understand that by submitting this application it authorizes my consent to complete this criminal background screening.

I understand that any misrepresentation, omission or falsification of any fact from this application will be cause for rejection of this application or dismissal from volunteer services.

Once you submit your application, you will be redirected to IntelliCorp's website, there you will submit the confidential information necessary to complete your criminal background screening.

The password is citrusgs.

Submit my application and connect me to IntelliCorp now.

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