Volunteer

General Info

Emergency Contact Info

Personal Info

Personal Info (Continued)

Background Check

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.