Volunteer Application

Volunteer Application

Community Justice Alternatives

2307 Midpoint Drive, Fort Collins, CO 80525 / Phone (970) 980-2600 / Fax (970) 980-2610

Alternative Sentencing Department

2307 Midpoint Drive, Fort Collins, CO 80525 / Phone (970) 980-2600 / Fax (970) 980-2610

Community Corrections Department

2255 Midpoint Drive, Fort Collins, CO 80525 / Phone (970) 498-7530 / Fax (970) 498-7511

Name*

(Last, First MI)

Alias

List any Alias' you have gone by

Email*

Address

Phone Number*

Where did you here about our program?*

Emergency Contact Info

Emergency Contact Name

Emergency Contact Phone

Emergency Contact Address

PERSONAL DATA

1) Are you now or have you ever been a Larimer County employee?*

Yes

2)Have you ever been convicted of, or are you now under indictment of any felony or misdemeanor other than a minor traffic violation? (Convictions are not an absolute bar to volunteer/internship placement).*

Yes

3) Have you ever been fired, forced, or asked to resign from a job, volunteer or internship position?*

Yes

To explain any YES answers, include the number of the question to which you are responding. This space may also be used to complete any other questions.*

Volunteer History

Organization/Agency

Volunteer Agency Location

Responsibilities

Start Date

End Date

Reason why you left volunteer agency

REFERENCES

Please list any professional or personal references

1st Reference Name*

1st Reference Phone Number*

1st Reference Address*

1st Reference Relationship*

2nd Reference Name*

2nd Reference Phone Number*

2nd Reference Address*

2nd Reference Relationship*

Additional Qualifications

List any other education, training, volunteer work or other relevant experience that would be of further assistance in evaluating your qualifications.

Please include hours per month or times per month you are available/interested in volunteering

Resume Upload

Please upload a photo of yourself and your resume here!

Drag and drop files here or

Volunteer PREA Screen and Criminal History Consent

In accordance with the Federal Prison Rape Elimination Act (PREA), Larimer County

Community Justice Alternatives (CJA) is required to run Criminal History and Warrant checks

on all employees, including Volunteers and Service Providers that work within CJA facilities or

on CJA grounds. In addition, CJA is required to screen for history of sexual misconduct.

DOB*

DL Number*

State*

Please answer the following questions

Have you ever engaged in sexual abuse or misconduct in a prison, jail, lockup, community confinement facility, juvenile facility, or other institution?*

Select

Have you ever been convicted of engaging or attempting to engage in sexual activity in the community that was facilitated by force, overt or implied acts of force, coercion, or if the victim did not consent or was not capable of consenting or refusing?*

Select

Have you ever been adjudicated in a civil case or an administrative hearing (at work or elsewhere) where you were found guilty of or admitted to any or all of the actions described in the previous two questions?*

Select

Please Type your full name to affirm your signature*

Signature Confirmation*

By checking this box, you are signing this document electronically. You agree your electronic signature is the legal equivalent of your manual/handwritten signature on this document. You further agree that your electronic signature on this document is as valid as if you signed the document in writing. You also agree that no certification authority or other third party verification is necessary to validate your electronic signature, and that the lack of such certification or third party verification will not in any way affect the enforceability of your electronic signature.

By checking this box, I also affirm that the information provided in this document is true and accurate to the best of my knowledge and belief and that the above name is my legal true name. I consent to Larimer County Community Justice Alternatives (CJA) running current CCIC/NCIC Criminal History and Warrant checks on me, and future checks during the time that I remain in a volunteer position or employed as a contract worker assigned to the facilities and grounds of CJA.

Send me a copy of my responses

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