Volunteer Application NCJJV

NUECES COUNTY JUVENILE JUSTICE CENTER
APPLICATION for VOLUNTEER/MENTOR/INTERN
Please check one of the following boxes for the purpose of this application:
Volunteer Mentor Intern
PERSONAL INFORMATION:
NAME: ______________________________________________________________________
ADDRESS: ___________________________________________________________________
CITY & STATE: ____________________________________________ ZIP: _____________
BIRTH DATE: _________________________ PLACE of BIRTH: _____________________
SS#: ___________________________________ SEX: MALE FEMALE
DRIVER’S LICENSE STATE & NUMBER: _______________________________________
HOME PHONE #: ______________________ WORK PHONE #: ______________________
E-MAIL ADDRESS: ___________________________________________________________
EMERGENCY CONTACT: ________________________________________________

Name
________________________________________________
Relationship
________________________________________________
Phone No: Home/Cell Work
1
EMPLOYMENT:
EMPLOYER: ____________________________________ HOW LONG? _______________
EMPLOYER’S ADDRESS: _____________________________________________________
______________________________________________________________________________
JOB TITLE: __________________________________________________________________
EDUCATION:
High School (Year Graduated) __________ GED _________
Or Last Grade Completed ____________
College / Trade School: _________________________________________________________
Degree or No. of Years Completed: _______________________________________________
Language, Other Than English: __________________________________________________
Special interests, skills or hobbies: ________________________________________________
______________________________________________________________________________
Special Groups/ Affiliations you have participated in: _______________________________
______________________________________________________________________________
OTHER INFORMATION:
Reason for wanting to Volunteer or Mentor or Intern with the Juvenile Probation
Department:
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
How many hours a week are you able to offer? _____________________________________
What days and hours? __________________________________________________________
2
HISTORY:
Have you ever been arrested? YES NO

If Yes, When? _________________________________________________________________
What were the charges? ________________________________________________________
______________________________________________________________________________
Have you ever been on PROBATION OR PAROLE? YES NO
If Yes, When? ____________________________________
Are you currently or have you ever sought help and received counseling or treatment for
emotional problems? YES NO
If Yes, When? ____________________________________
REFERENCES:
List someone who has known you at least one year. Please do not list any family members.
1. ________________________________________________________________
Name
__________________________________ _______________________
Contact Phone Number Years Known
________________________________________________________________
Address City & State Zip
________________________________________________________________
Employer Occupation
2. ________________________________________________________________
Name
___________________________________ _______________________
Contact Phone Number Years Known
________________________________________________________________
Address City & State Zip
________________________________________________________________
Employer Occupation
3
RELEASE OF LIABILITY & PLEDGE
I do hereby give permission to the Nueces County Juvenile Department to investigate my
background and character. I fully understand that my employer and my references may be
contacted and that a criminal records check will be conducted by the appropriate law enforcement
agency. By submitting this application, I hereby release the Nueces County Juvenile Department
of all liability that might inadvertently result to my reputation, employment, or financial status as
a result of any contact by the Nueces County Juvenile Department with my employer, law
enforcement agencies or personal references.
I understand that if accepted as a Volunteer or Mentor or Intern (which ever may apply)
with the Nueces County Juvenile Department, I will be required to participate in the
orientation program, familiarize myself with the policies and procedures of the Nueces
County Juvenile Department, and will protect the confidentiality of all client rights. I also
agree to conduct myself in a dependable and responsible manner. I understand that my
services at Nueces County Juvenile Department may be terminated at any time.
_____________________________________________
Print Name
______________________________________________ ___________________
Signature Date
Please return to:
Nueces County Juvenile Department

2310 Gollihar Road
Corpus Christi, Texas 78415
(361) 855-7303

Volunteer Application NCJJV

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NUECES COUNTY JUVENILE JUSTICE CENTER

APPLICATION for VOLUNTEER/MENTOR/INTERN

Volunteer Mentor Intern

CITY & STATE: ____________________________________________ ZIP: _____________

BIRTH DATE: _________________________ PLACE of BIRTH: _____________________

SS#: ___________________________________ SEX: MALE FEMALE

DRIVER’S LICENSE STATE & NUMBER: _______________________________________

HOME PHONE #: ______________________ WORK PHONE #: ______________________

E-MAIL ADDRESS: ___________________________________________________________

EMERGENCY CONTACT: ________________________________________________

EMPLOYER: ____________________________________ HOW LONG? _______________

EMPLOYER’S ADDRESS: _____________________________________________________

JOB TITLE: __________________________________________________________________

High School (Year Graduated) __________ GED _________

Or Last Grade Completed ____________

College / Trade School: _________________________________________________________

Degree or No. of Years Completed: _______________________________________________

Language, Other Than English: __________________________________________________

Special interests, skills or hobbies: ________________________________________________

Special Groups/ Affiliations you have participated in: _______________________________

How many hours a week are you able to offer? _____________________________________

What days and hours? __________________________________________________________

Have you ever been arrested? YES NO

What were the charges? ________________________________________________________

If Yes, When? ____________________________________

If Yes, When? ____________________________________

Please return to:

Nueces County Juvenile Department

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CITY & STATE: ________________________________ ZIP: _

BIRTH DATE: _____ PLACE of BIRTH: _

HOME PHONE #: WORK PHONE #:

EMPLOYER: ______________________ HOW LONG? _

High School (Year Graduated) __ GED _