Name *

First Name

Last Name

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone *

(###)

###

####

Are you applying to serve with Jobs for Life or Elevate Teams?

Jobs for Life Mentor

Jobs for Life Childcare

Elevate Mentor

Date of Birth *

MM

DD

YYYY

Gender

Male

Female

Ethnicity

African-American

Asian

Caucasian

Hispanic

Native American

Other

Highest Education Level Completed: *

Some High School

12/GED

Vocational Training

College

Graduate School

Post Grad

Do you agree to have a Sex Offender and Child Abuse/Neglect Registry check and/or a Criminal History check?

Yes

No

Do you have a criminal history? *

Yes

No

Check all that apply: *

Unemployed

Employed Part-time

Employed Full-time

Self-Employed

Retired

Have you volunteer with STEP before? *

Yes

No

What volunteer role are you most interested in? (check all that apply) *

Mentor

Class Instructor

Meal Provider

Childcare Provider

Mock Interviewer

Business or community resource partner

I certify that all information contained in this form is true to the best of my knowledge. *

First Name

Last Name

Date *

MM

DD

YYYY

I hereby authorize that STEP may use photos, videos, or other digital images taken of me or my child(ren) at a STEP class or event to promote the ministries of STEP.

First Name

Last Name

I understand that all activities entail potential risk of harm, bodily injury, or illness. I voluntarily agree to accept any risk of harm, injury, or illness (including COVID-19) arising from my participation in this program, and I hereby release STEP ministries from any and all liability for any injury, illness or other damage resulting from the program activities. *

First Name

Last Name

Date *

MM

DD

YYYY

I am a person of faith, and I am in agreement with the STEP Statement of Faith.

Please review the STEP statement of faith at https://www.steprichmond.org/statement-of-faith

First Name

Last Name

Date

MM

DD

YYYY

I am not a person of faith, but I agree to not contradict the Statement of Faith by word or behavior while participating in STEP activities.

First Name

Last Name

Date

MM

DD

YYYY