Girl Scouts of Camden County NJ, Inc. 40 Brace Road Cherry Hill, N.J. 08034 (856) 795-1560 Name: Social Security #: Address: City: Zip Home Phone: Work Phone: Date of Application: E-Mail Address: Drivers License # and State Auto Ins.Co. Have you ever had your license suspended or revoked? yes no If yes, when and why: Have you ever been convicted of a crime, including sex related or child abuse related offenses? yes no If yes, enter complete details of circumstances, including when and in what jurisdiction. (Note: a conviction record will not necessarily be cause for disqualification) Other than matters above, is there any reason, or circumstances, that you should not be entrusted with supervision and leadership of youth? Occupation Employer Full-time Part-time Please list three references who can attest to your character, skills and dependability. Do not list relatives. All references will be contacted. Appointment will be made only after references are verified. If employed, please list a work related reference.
Name Address/City/St/Zip
Position Desired: Leader Co-Leader Service Team What age group would you like to work with? Daisy (Kindergarten age) Junior (4th, 5th, 6th Grade) Brownie (1st, 2nd & 3rd Grade) Cadette/Senior (Jr. & Sr. High) What hours are you available? Afternoon Evening Weekends How did you learn about this position? Why are you applying to become a Girl Scout Volunteer? Is there a specific troop that you’d like to work with? Which elementary school do you live closest to? Years in Girl Scouting As a girl As an adult Previous Council (Previous Girl Scout Experience NOT a prerequisite) VOLUNTEER EXPERIENCE Participation in other organizations (as an adult)
Name of Group/Organization # of Years Awards/Positon Held Interests, skills,hobbies: Check special training or certification & give date of expiration:
In making my application for service, I express my acceptance of the purpose of Girl Scouting. I am willing and able to take training and will participate in adult activities in the Girl Scout program. I express my acceptance of Girl Scouts of Camden County’s affirmative action policy to ensure fair and equal treatment, in all its practices, to all persons, regardless of race, color, religion, sex, national origin, sexual orientation, disability, age or socioeconomic status.
I certify that all information provided on this application is true and complete. I understand that falsification or significant omissions of any information may be considered justification for non-acceptance or dismissal if discovered at a later date.
____________________ Signature