Youth Connections Unlimited is a 501(c)(3) non-profit organization dedicated to working with “high risk” young people.

Your tax deductible donation would be greatly appreciated in helping us work with young people and can be mailed to:

Youth Connections Unlimited
3053 Freeport Blvd. #418
Sacramento, CA 95818

Volunteer in Probation Application

For more information call: David Taft, 916-717-8657 or email

Last Name

First Name

Middle Initial

Address

City

State and Zip Code

Telephone (home)

Telephone (cell)

Male
Female

SS#

Date of Birth

Place of Birth

Maiden or other name used

(Social Security number, other names used and date of birth are used for background check purposes only)

Drivers License #

State

Expiration Date

Emergency Contact Person

Emergency Contact Phone Number

Relationship to Volunteer

Occupation

Employer

Phone

Length of Employment

Can you be contacted at this number?

Describe your health/ insurance

Highest Grade completed?

School

City

Special Courses and/ or Degrees

Languages spoken fluently

Hobbies & Skills

Organizational affiliations, clubs,etc

Previous volunteer experience.

Automobile Insurance Information

It is necessary for you to have the following insurance coverage for your protection should you transport another person: Sufficient public liability and property damage insurance at least equal to the requirements of the financial responsibility laws of the State of California (Vehicle Code Section 16430)

1. Does your policy meet requirements:

2. Has your policy ever been cancelled, rescinded or lapsed?

Name of insurance company:

Policy #

Agent’s Name

Address

Vehicle License #

Background Information

Conviction of a crime is not necessarily a bar to becoming a volunteer. Each case is considered separately based upon volunteer requirements.

1. Have you ever been convicted by any court of an offense? Omit minor traffic infractions (Note: Drunken driving, reckless driving, hit & run are not minor infractions). Include juvenile, adult, and military offenses. If “yes”, please furnish the following information:

If yes to above question, please enter the DATE, OFFENSE, CITY and STATE and DISPOSITION. Conviction of a crime is not necessarily a bar to becoming a volunteer. Each case is considered separately based on volunteer requirements.

Date	Offense	City & State	Disposition

2. Has your driver’s license ever been revoked or suspended?

Yes No

3. Do you know or are you related to anyone who has been on Probation within the past 5 years? (If yes, please describe)

Name

Relationship

State

Crime

When

Where

4. Do you know or are you related to anyone, adult or juvenile presently incarcerated? If yes, please describe)

Name

Relationship

State

Crime

When

Where

References

Please provide the names, addresses, and phone numbers of two people for reference purposes. One must be a person who is neither a relative nor someone living with you.

Reference #1

Name #1

Address #1

City #1

State #1

Zip #1

Phone #1

Email #1

Reference #2

Name #2

Address #2

City #2

State #2

Zip #2

Phone #2

Email #2

Volunteer Permission

I give permission for the Sacramento County Probation Department to request a reference for volunteering in Probation from the above listed personal references (#1 & #2).

Signature

Date

Volunteer Information

1. Where did you hear about us?

2. What days and hours are you available? Please list the DAYS and TIMES for these days you can volunteer.

Day of Week	From (indicate hour)	To (indicate hour)
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday

3. Why are you interested in a volunteer position with the Probation Department??

I am interested in volunteering for:
Leadership Athletics Education Programs (LEAP) Specify: Foster Grandparent (YDF) Chaplaincy (YDF)	Youth Connections Mentor/Tutor Specify: Neighborhood Accountability Board Member (Field) Student Intern Other

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Volunteer in Probation Application