Schwartz Center for Children

Application for Volunteer/Student intern positions

We consider applicants for all positions without regard to age, race, religious creed, national origin, sex, sexual orientation, criminal record, mental illness, handicap/disability or any other legally protected status pursuant to
Massachusetts Fair Employment Practices Act, and other relevant federal, state and local laws.

C.O.R.I. Requirement - as required by OCCS, Department of Education and the Department of Public Health, a CORI (Criminal Offender Record Information) check will be required by all volunteers. A satisfactory completion of this process is required for placement here at the Schwartz Center. Fields marked with an "*" are required.

Your Information

Position Applied For:

Email Address:

First Name:

Last Name:

Middle Name:

Present Address:

City:

State:

Telephone:

format: (555) 555-5555

General Information

Have you ever been involved with this Center before?

	No

	Yes - When?

In case of an emergency, whom should we contact?

Name

Relationship

Telephone Number
format: (555) 555-5555

Your History

Have you even been arrested, indicated or summoned into court as a defendant, fined, convicted, imprisoned, or placed on probation for any reason whatsoever?

	No

	Yes - Give Details

Have you ever been dismissed or forced to resign from any position?

	No

	Yes - Give Details

Have you ever been arrested for, or convicted of a violation of the narcotics drug law, or laws, relating to sexual offenses?

	No

	Yes

Educational History

High School

Years Completed

Where

Year Left

College

Years Completed

Where

Year Left

More Information

Describe any further details of your training or education which are pertinent?

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