Ngozi Place HCS Volunteer application

By filling out this application, you are agreeing to have your name run through the following databases; Texas criminal Background Check, Office of Inspector General (Federal) & (Texas), as well as the HHS Employability Status Check. This agreement & search does not guarantee you will be asked to volunteer.

Please provide (3) references.

These references do not have to live in the state of Texas.

Begin Here. Please read the entire form carefully.

Name

First Name

Last Name

What is your Phone Number?

This number will be used to contact you for an interview via text.

(###)

###

####

What's your Date of Birth? (Day, Month, Year you were born.)

You must be at LEAST 18 years old at the time of your application.

YYYY

Social Security Number

Used to verify identity

If you have a VALID Driver License, add the DL# below.

If you do not currently have a VALID DRIVER LICENSE, place N/A in the box below.

Add your CURRENT home adress - Include Street # / Street Name / City / State / Zip Code

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

(1) Use the box below to describe your experience working with people with Intellectual and/or Developmental Disabilities.

(2) If you have no experience working with people with IDD diagnosis, please provide your most RELEVANT job experience to direct care work.

Have you worked at Ngozi Place HCS before?

No, I have not been employed at Ngozi Place HCS.

Yes, I have worked for Ngozi Place HCS before.

I am aware this is application is for a volunteer position with Ngozi Place HCS, which is a long - term healthcare program who serves Individuals with Intellectual and or Developmental Disabilities.

Yes, I am aware this is a long - term healthcare company for people with Intellectual and Developmental Disabilities.

No, I do not understand and would not like to pursuit this position at this time.

Add your (1st) state required reference below. All (3) references are required as part of processing your application.

Include their First and Last name of the person, How you know the person, and their phone number.

Add your (2nd) state required reference below. All (3) references are required as part of processing your application.

Include their First and Last name of the person, How you know the person, and their phone number.

Add your (3rd) state required reference below. All (3) references are required as part of processing your application.

Include their First and Last name of the person, How you know the person, and their phone number.

How did you hear about Ngozi Place?

Use the drop down menu below.

If CURRENT STAFF member referred you to our company, please list their First and Last name below.

By adding your name below, you are affirming to the best of your knowledge everything in this application is true. Please note, the person whose name is on this documentation should be capable of filling this information out by them selves, without assistance.

Add your FIRST and LAST name.

What is today's date? (Date of the Application)

YYYY

You understand this application is for a volunteer opportunity at Ngozi Place HCS

Yes