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I. Personal Information
Volunteer Interests
II. Background Checks

Applicants will be screened for criminal convictions and sanctions through the Bureau of Criminal Investigations, the ND Board of Nursing, Child Abuse Registry, Sexual Offenders Registry Index, and Department of Transportation.

III. Referral Sources
If employee or other, please be specific
IV. References

Please list three references that you have known for at least 1 year.
Please fill out all information completely.

V. Promotional Materials
Applicant's Statement

I certify that all answers given by me are true, accurate and complete.  I understand that the falsification, misrepresentation or omission of fact on this application (or any other accompanying or required documents) will be cause for denial of volunteer opportunities or dismissal from volunteer work regardless of when or how discovered.  I acknowledge that I have read and understood the above statements and hereby grant permission to confirm the information supplied on this application by me.


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