Nebraska Aftercare In Action Volunteer Application Packet
NAIA GENERAL INFORMATION
Our Social Contract
NAIA is a volunteer program designed to help inmates transition back into society.
The Objective:
“Helping inmates connect to local resources to that they can successfully reenter our communities.”
Who are the Volunteers?
The volunteers are people in our communities from young adults to seniors who have a desire to help returning citizen’s transitioning back into society.
What are the volunteer’s responsibilities? Complete the volunteer application process.
- Complete the volunteer training.
- Meet with the participant twice a week, for one hour or longer, and provide this support at least up to 6 months.
- Implement program models and guidelines provided in training.
- Inform Area Coordinator of concerns and progress.
(Revised 1 June 2010)
NEBRASKA Aftercare In Action
Volunteer APPLICATION PROCESS
- Volunteer Data Sheet: Please complete by typing or printing in black ink only and return to the NAIA Area Coordinator as soon as possible.
- Criminal History Check Authorization and Information Form, Notice and Authorization Regarding Criminal Record Check: Please complete by typing or printing in black ink only and return to the NAIA Area Coordinator at training.
- Personal Reference Letters: You are required to submit three letters of reference. Please photocopy the original found in this packet, fill out the top portion and send one letter to each reference. Two letters can be from family and/or friends. One of the reference letters should be from a professional.
- Acceptance: NAIA has the right to accept, deny, or remove a volunteer based on incomplete application forms or unfavorable background checks and/or references. Please sign and date below and return to NAIA.
I understand that it is my responsibility to see that all forms required for becoming a volunteer with NAIA are returned and that failure to do so will result in my denial or removal as a core team volunteer.
Signature______Date______
NEBRASKA Aftercare In Action
VOLUNTEER DATA SHEET
(Please type or print in black ink only)
Date: ______
Last Name: ______First: ______M.I.: _____
Address: ______
City: ______State: ______Zip:______
Phone: Home ______Work______Cell______
E-Mail:______
Driver’s License # ______State: ____ Exp. Date: ______
Date of Birth: ______
Emergency Contact: ______Phone:______
Current Employer: ______
Position/Title: ______
Supervisor: ______Phone: ______
Current School: ______
Highest level of education obtained______
Why are you interested in becoming a NAIA volunteer?
What experience will you bring as a NAIA volunteer?
Have you ever been convicted of a felony? _____ If yes, please explain? In most cases this will not preclude you from becoming a volunteer.
Please list three individuals (not related to you) as character references. If you are employed, include your supervisor.
- Name:______Phone:______
- Name:______Phone:______
- Name:______Phone:______
______
Date of Birth
______
First Middle Last
Print name clearly
I believe NAIA has run a background check on me within the last 3 years.
cYes cNo If Yes, for what position______
CRIMINAL HISTORY CHECK AUTHORIZATION AND INFORMATION FORM
This form is to assist NAIA in conducting a Criminal History Check of applicants, employees, contractors, and volunteers. Please complete all of the Criminal History information requested.
CONVICTION OF A CRIME IS NOT AN AUTOMATIC BAR TO CONSIDERATION FOR EMPLOYMENT, CONTINUED EMPLOYMENT, OR VOLUNTEER SERVICE. FACTORS SUCH AS THE DATE OF THE OFFENSE, THE TIME PERIOD BETWEEN THE OFFENSE AND THE PRESENT, THE NATURE AND SERIOUSNESS OF THE OFFENSE, AND REHABILITATION WILL BE CONSIDERED BY THE BOARD.
CRIMINAL HISTORY INFORMATION
Applicants for employment, volunteers and employees are requested to provide information on this Criminal History Information. The information will be used solely for the purpose of assisting in conducting a criminal history check. Failure to provide all of the information requested will result in rejection of an applicant or removal from volunteer service.
Name______SSN______
Current Address ______Length of Time______
Street City State Zip
Current Phone Numbers: Home: ______Work:______Cell:______
List Complete Addresses of last seven years:
Address______Length of Time___to ____
Street City State Zip
Address______Length of Time___to ____
Street City State Zip
Address______Length of Time___to ____
Street City State Zip
Address______Length of Time___to ____
Street City State Zip
Date of Birth ______Driver’s License #______State______
List all former names and Aliases, including dates and locations of use ______
______
Have you ever pled guilty or nolo contendre (no contest) or been convicted of any criminal offense (misdemeanor or felony) other than parking tickets? ______Yes ______No
If yes, provide complete information on all criminal offense(s), date(s), locations(s) (city and state) and disposition: ______
______
(use additional sheets if necessary)
Are you currently serving any of the following for any criminal offense? (Check appropriate box)
______pre-trial diversion ______community supervision
______suspended sentence ______probation without adjudication of guilt
______probation ______deferred adjudication
______deferred sentence ______community corrections program
______home detention ______any other alternative sentence (identify)
If yes, provide complete information on the criminal offense, type and current status of program and expected completion:______
______
(Use additional sheets if necessary)
Have you previously served any of the following for any criminal offense? (Check appropriate box)
______pre-trial diversion ______community supervision
______suspended sentence ______probation without adjudication of guilt
______probation ______deferred adjudication
______deferred sentence ______community corrections program
______home detention ______any other alternative sentence (identify)
______
If yes, provide complete information on the criminal offense, nature of program and date of completion:______
(use additional sheets if necessary)
Acknowledgment
I acknowledge that I have read and understand this form and certify that the above information and representations are true, correct and complete and contain no omissions. I understand that false, incorrect, misleading or incomplete information on this form will result in rejection of my application or termination if employed, or cessation of volunteer service.
I understand that NAIA will request a criminal history check after making a conditional employment offer or accepting my request for volunteer service in certain programs and at certain times during employment (such as promotion, transfer, or evaluation). NAIA is required to submit certain identifying information in order to obtain a criminal history check. I authorize use of the information provided on this form for this investigation. I also understand that additional information, including fingerprints, may be required in order to complete the criminal history check. I agree to provide additional information (including fingerprints) if requested by NAIA. I understand that if the criminal history check discloses a conviction or other action which would make me unsuitable for employment or volunteering in the position for which I have applied or in which I am working, I will be considered ineligible for employment or volunteer service.
______
Employee/Applicant/Volunteer Signature Date
Nebraska Aftercare In Action
PERSONAL REFERENCE
(Please type or print in black ink only)
Return to: NAIA
By Date: ______
______ has provided your name as a reference to be used in evaluating his/her application to serve as a volunteer for the NAIA. Volunteers will help participants with the transitioning from prison to society. It is critical that a volunteer works well with people and can make the time commitment of approximately 2 hours per week for six months. A standard part of our screening process is to verify personal references. Consequently, your response carries significant value and is greatly appreciated. Please know that any information you divulge is confidential and is not revealed to the applicant. If you do not feel comfortable recommending this applicant simply answer Question #1, sign, and return the form. Please answer the following questions honestly and return promptly.
1. Do you know any reason why the applicant would not be able to help a returning citizen transition from prison to society? ______If yes, please explain. ______
2. What is your relationship to the applicant? ______
3. How well do you know the applicant? Very well____ Well_____ Not well____
4. Applicant’s relationship to others: (check as many as applicable)
a. Impatient ____ g. Understanding ____
b. Well-liked ____ h. Strict ____
c. Friendly ____ i. Patient ____
d. Distant ____ j. Confident ____
e. Rigid ____ k. Aggressive ____
f. Reliable ____ l. Unknown ____
5. How well does the applicant assume responsibility?
a. Excellent ____
b. Average ____
c. Fair ____
d. Poor ____
6. Check as many of the following that describe the applicant’s temperament.
a. Varying ____
b. Stable ____
c. Easily upset ____
d. Impatient ____
7. Would you recommend the applicant as a personal friend for someone close to you?
a. Yes ____
b. No ____
8. Please use the space below to make additional comments: ______
Thank you for your time.
______
Print and sign name
Date______