HAVE YOU OR YOUR FAMILY HAD PERSONAL/PROFESSIONAL EXPERIENCE WITH:
PLEASE ANSWER THE FOLLOWING QUESTIONS AND GIVE DETAILS IF ANSWER IS YES:
PLEASE RESPOND TO THE FOLLOWING:
Please provide COMPLETE contact information for three non-family references that have known you for at least one year.
Please do not list a relative or significant other. If possible, please list an employer or supervisor.
I hereby affirm that all of the answers provided on my volunteer application are true. I hereby authorize ADAKC, and any law enforcement agency they authorize, to investigate my background to determine my fitness as a potential volunteer.
I understand that the information requested in this application will be used only for the purpose of determining my suitability as an ADAKC volunteer. I am aware of the sensitive and confidential nature of the official documents, reports and other material I will examine in my capacity as a ADAKC volunteer. I will discuss these matters only with those persons directly involved in the program or who will be consulted for their professional knowledge and expertise.
I also understand that if for any reason it becomes apparent that my activities are contrary to the policies, goals and/or philosophy of the ADAKC program, and their desire to provide quality services to families affected by Alzheimer's Disease, Dementia and other related disorders, my services as a ADAKC volunteer will be terminated.
I submit the statements on this application are true, complete, and correct to the best of my knowledge. I understand that falsification on this application can disqualify me from consideration or can result in dismissal at a later time.