Girl Scouts of Wisconsin Southeast
Volunteer Application

By completing this form, you are assuring a high quality, safe program for all girls. A component of this program is careful selection and placement of volunteers. Recognizing the vital contribution of volunteers to the Girl Scout Movement, Girl Scouts of Wisconsin Southeast seeks to make participation in the organization personally and professionally rewarding to all volunteers. There shall be no discrimination against an otherwise qualified adult by reason of disability or on the basis of age, race, color, ethnicity, sex, creed, national origin or socioeconomic status. The council will also actively comply with federal, state and local laws and regulations.

Last Name:

First:

MI:

Address:

Phone (day):

City:

Phone (eve):

State:

Zip:

Email:

Are you 18 years or older?		Yes No
Do you have a valid driver's license?		Yes No State:
Do you have auto liability Insurance?		Yes No

Volunteer positions desired?
At (school and city):

List three individuals not related to you who can describe your qualifications for the positions(s) you listed above:
Name	Phone (day)	Email Address

Education: (High School, College, Graduate School)
School & Location	Grade Completed

Employed Experience: (List Most Recent First)
Position	Employer	Dates

Other Training & Skills (courses, certification)
Name	Agency

Volunteer Experience: (List youth-related experience first)
Position	Agency	Dates

1. Do you use illegal drugs? No Yes

2. Have you ever been convicted of a crime? No Yes

3. Are there any current criminal charges pending? No Yes

4. Have you ever been charged with child abuse or neglect? No Yes

5. Has your driver's license ever been suspended or revoked with the last five years? No Yes

6. Are there any other facts or circumstances involving you or your background that would call into
question your being entrusted with the supervision, guidance and of young people or the handling
of finances? No Yes

If you answered yes to any of the previous questions, please explain:

I am familiar with and subscribe, without reservation, to the principles embodied in the Girl Scout Promise and Law. I understand that it is my responsibility as a volunteer to comply with the agreement as stated on the back. I affirm that I have never been convicted of any offense against children. I also consent to the council verifying information included on this application form, including checking references, criminal background checks, and conducting further screening as required by law with the understanding that all this information will be kept confidential by Girl Scouts of Wisconsin Southeast. 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. When driving girls, I will have a current, valid driver's license and carry the necessary automobile insurance, or the equivalent, as required by law in the State of Wisconsin or I will not drive anyone involved in a Girl Scout activity. Pending charges or past criminal convictions are not an absolute bar to volunteering with Girl Scouts and those situations will be considered only if there is a substantial relationship to the circumstances of the volunteer position.

This agreement outlines the mutual responsibilities of
Girl Scouts of Wisconsin Southeast, and its volunteers.

The council agrees to:
	Provide a copy of the volunteer policies.
	Provide a position description.
	Provide a letter of appointment.
	Provide orientation to the position, the council, and the organization.
	Offer relevant training for the position.
	Give recognition for time and energy devoted to the position.
	Carry liability insurance and supplementary accident insurance as part of the national and/or council membership.
	Provide ongoing support, resources, guidance, and feedback.

The volunteer agrees to:
	Register as a member of the Girl Scout Movement.
	Complete the Application form.
	Devote sufficient time and energy to fulfill outlined position requirements.
	Support the purpose and values of the Girl Scout Movement and the council activities and goals.
	Comply with council and GSUSA policies and safety standards and guidelines.
	Complete position-related training.
	Attend scheduled meetings for ongoing support and feedback.
	Be a positive role model in all interactions.
	Promote understanding and appreciation of individual, cultural, religious and racial differences.
	Complete year-end questionnaire.