Youth Volunteer Application (ages 12-17) Please complete the application form and return to the Duluth Children’s Museum (115 S 29th Ave W Duluth, MN 55806) or email Aaron Slonecker at [email protected]. First Name Address Last Name City Home Phone Middle Initial State Zip Cell Phone E-mail Address DOB (mm/dd/yyyy) Em SCHOOL INFORMATION School Name Address Current Grade Level City State Zip EMERGENCY CONTACT INFORMATION Contact Relationship Contact Address City Home Phone Number Work Phone Number State Zip Cell Phone Number AVAILABILITY Time commitment: Please indicate how many hours per week you would prefer to volunteer:_________ 1 Duluth Children’s Museum Criminal Background Checks Policy POLICY Out of concern for the well-being and safety of the children and families we serve, the Duluth Children’s Museum performs criminal background checks on youth volunteers. The Duluth Children’s Museum deems it necessary and advisable as a matter of policy to reserve the right to disqualify and prohibit any person from serving as a volunteer, including one who has been arrested for, convicted of, been on probation for, or received deferred adjudication for any criminal conduct. The right to disqualify applies to any criminal conduct regardless of whether (a) the criminal charges were subsequently dropped and the applicant was never prosecuted for the crime charged or (b) the criminal charges resulted in a non-conviction such as probation, or (c) the criminal conviction was subsequently removed from the applicant’s record as the result of appropriate legal proceedings. PROCEDURES In order to screen prospective volunteers to identify those who have engaged in criminal conduct, the Duluth Children’s Museum adopts the following procedure: a) Application: Each volunteer is required to fill out an application. b) Personal Interview: Certain volunteer roles may require a prospective volunteer to undergo an interview with appropriate staff members. c) Criminal Background Checks: Each prospective volunteer will give written consent for a criminal background check. COMPLIANCE WITH REQUIREMENTS The Duluth Children’s Museum will comply with the requirements of the Criminal Information Act, including the destruction of criminal history record information promptly after the determination of the suitability of the volunteer. **Parental Consent for Criminal Background Check** I ___________________________ have read the criminal background check policy and grant my child, ____________________________ ,permission to undergo this check for the purpose of volunteering at the Duluth Children’s Museum. ________________________________________ Parent Signature _________________________ Date 2 Criminal Background Check Informed Consent Form Duluth Children’s Museum 115 S 29th Ave W Duluth, MN 55806 Date: Last name of applicant (please print):________________________________ First name (please print):___________________________________________ Middle (full) (please print):__________________________________________ Maiden, Alias, or Former (please print): Date of Birth: ____________________ Sex (M or F):________________ (mm/dd/yyyy) Social Security Number: __________________________________________ Address (No PO Boxes): Street Apt. # City State Zip County:________________________________________________________ Phone: ________________________________________________________ Have you ever been convicted of a crime and are there any legal charges pending against you?__________ If yes, please explain: ___________________________________________________________________________________________________ ___________________________________________________________________________________________________ I authorize the Minnesota Bureau of Criminal Apprehension to disclose all criminal history record information to the Duluth Children’s Museum for the purpose of volunteering with this agency. The expiration of this authorization shall be for a period no longer than one year from the date of my signature. Signature of Applicant Date (please cut along dotted line) RECEIPT FOR YOUR RECORDS I, _________________________, have paid $5.00 (cash, check) to the Duluth Children’s Museum for my Volunteer Criminal History Records Check on____/____/____. ____________________Duluth Children’s Museum Staff 3 Duluth Children’s Museum Parental Permission for Youth Volunteer Youth volunteers play an integral role in helping the Duluth Children’s Museum achieve its mission of sparking children’s curiosity. The Duluth Children’s Museum strives to provide a safe, professional, and fun work environment for all volunteers. As museum staff, we will ensure your child, as a youth volunteer, will: 1. 2. 3. 4. Be treated with kindness and respect by all museum staff. Receive clear directions and adequate materials to accomplish the tasks he or she has been given. Learn important job skills related to customer service, working with children, and interacting with others in a professional work setting. Receive constructive feedback as it pertains to his or her volunteer responsibilities. As a parent you contribute to the success of your child’s volunteer experience at the Duluth Children’s Museum. Please help your son or daughter to: 1. 2. 3. Complete this volunteer application along with the background check. Set a consistent schedule for volunteer hours. Arrange timely transportation to and from the Duluth Children’s Museum. Parental Permission I have read this volunteer application and grant my child, _______________________, permission to volunteer at the Duluth Children’s Museum. Signed: ___________________________________________ Date:_____________________________________________ 4