Protecting Children Is What We Do

* Name:		* Your E-mail:
* Street		* City
* State		* Zip
* Occuption		* Employer
* Business Address		* Social Security Number (You may call our office (458-7009) to give SS#)
* Date Of Birth		* Can We Call You At Work?	Yes No
* Home Phone		Work Phone
Cell Phone		* Available Times
* I Am Interested In Volunteering For: Search Force Child Safety Events/Fingerprinting Fund Raising Events Office Support/Translation Of Resource Materials Safety Presentation In Schools Helping Families To Distribute Missing Children Fliers E-Volunteer Flier Team		* Are You Bilingual?	Yes No
If Yes, What Language(S)?		Special Skills, Hobbies Or Interests That May Be Utilized At Events, etc:
Do You Presently Have Or Have You Ever Had:	Narcotic Habit? Excessive Drinking Habit?	If Yes, Please Explain:
* Have You, Since Age 18, Ever Been Convicted Of A Violation Of Any Federal, State, Country Or Municipal Law, Regulation Or Ordinance (Also Military Court Martial)? Yes No
CONVICTIONS:
* Date Of Birth		Charge:
City/State Where Convicted:		Are You Presently On Probation, Parole Or Pending Trial For A Crime?	Yes No
I hereby authorize Nevada Child Seekers to conduct the necessary check and obtain any necessary information required, and release Nevada Child Seekers from any liability resulting from this investigation. I understand that my application must be cleared through the Police Department in addition to the investigation.		I agree to the following consent and release:	Yes No
Code Verification:

Volunteer Application