Volunteer Interest Form

Volunteer/Intern Interest Form

  • Please list any special needs or limitations
  • All references will be checked. Please include Name, Occupation, Contact Number, Relationship
  • Date Format: MM slash DD slash YYYY
    Ongoing volunteer opportunities require a Level II background screen.
    I understand that IMPOWER performs Local, State and Federal background checks on all volunteers. I hereby give my permission for IMPOWER to obtain information relating to my criminal history record. I understand that this information will be used to determine my eligibility for a volunteer position with this organization. I also understand that as long as I remain a volunteer with IMPOWER. IMPOWER may repeat this criminal history records check at any time.
  • I hereby affirm that my answers to the forgoing questions are true and correct and that I have not knowingly withheld any fact or circumstance that would, if disclosed, affect my application unfavorably. I understand that any false information in this application may result in my discharge.

    I understand that as a volunteer of IMPOWER I am prohibited from transporting clients at any time.