Has any member of your family, a friend or acquaintance, ever been supervised on probation or diversion by this agency? Yes No If yes, please explain: Are you currently involved in a court matter in Minnesota or any other jurisdiction? Yes No If yes, please explain: Do you have any close friend or family member under any type of court jurisdiction, and/or in any correctional/placement/institution/facility? Yes No (This will not disqualify you.) If yes, please list name(s) and relationships: List where you have lived the past five (5) years other than Blue Earth County: Have you ever been asked to resign or been terminated by an employer or a volunteer training program? Yes No If yes, please explain: Records checks will be done on all volunteer applicants. A conviction does not disqualify a volunteer. It is generally necessary for a person to have made a satisfactory community adjustment for at least one year and/or subsequent completion of probation before acceptance is considered. REFERENCES Name Address Telephone Relationship Years Known 1. 2. 3. References will be checked. My signature below certifies that all statements made on this application are true, complete, and correct to the best of my knowledge. I understand these statements are subject to verification. I understand the falsification of this application can disqualify me from consideration or result in dismissal upon discovery. Furthermore, my signature below provides my authorization to Blue Earth County Corrections to do driver and criminal record checks, as well as reference checks to determine my suitability for placement. Signature Date Blue Earth County Community Corrections acknowledges that equal opportunity for all persons is a fundamental human value. The volunteer program considers each applicant on the basis of individual ability and merit, without regard to race, color, creed, age, religion, national origin, sex, handicap, sexual orientation, marital status or public assistance status.
Has any member of your family, a friend or acquaintance, ever been supervised on probation or diversion by this agency? Yes No If yes, please explain: Are you currently involved in a court matter in Minnesota or any other jurisdiction? Yes No If yes, please explain: Do you have any close friend or family member under any type of court jurisdiction, and/or in any correctional/placement/institution/facility? Yes No (This will not disqualify you.) If yes, please list name(s) and relationships: List where you have lived the past five (5) years other than Blue Earth County: Have you ever been asked to resign or been terminated by an employer or a volunteer training program? Yes No If yes, please explain: Records checks will be done on all volunteer applicants. A conviction does not disqualify a volunteer. It is generally necessary for a person to have made a satisfactory community adjustment for at least one year and/or subsequent completion of probation before acceptance is considered. REFERENCES Name Address Telephone Relationship Years Known 1. 2. 3. References will be checked. My signature below certifies that all statements made on this application are true, complete, and correct to the best of my knowledge. I understand these statements are subject to verification. I understand the falsification of this application can disqualify me from consideration or result in dismissal upon discovery. Furthermore, my signature below provides my authorization to Blue Earth County Corrections to do driver and criminal record checks, as well as reference checks to determine my suitability for placement. Signature Date Blue Earth County Community Corrections acknowledges that equal opportunity for all persons is a fundamental human value. The volunteer program considers each applicant on the basis of individual ability and merit, without regard to race, color, creed, age, religion, national origin, sex, handicap, sexual orientation, marital status or public assistance status.