Let's Make A Difference.

Volunteer Application

What's your name? *

First

Last

Home Address *

Address Line 1

Address Line 2

City

State

Zip Code

Business Address (Optional)

Address Line 1

Address Line 2

City

State

Zip Code

Your Phone Number *

Your Email *

Preferred Mailing Address *

Home
Work
Email Address
No Preference

Are you willing to provide transportation for volunteer activities? *

Are you meeting a need for Community Service? (Optional)

Legacy, Texas Scholars, etc.

Emergency Contact Information

Name *

First

Last

Phone Number *

Relationship *

Mother, Father, etc.

Security Statement:

Due to the nature of the services Spectrum of Solutions provides, each volunteer applicant must consent to criminal history background and driving record checks. For example, suppose a criminal history check indicates you have been convicted of or granted deferred adjudication or any other type of pretrial diversion for any criminal offense. In that case, Spectrum of Solutions will, on a case-by-case basis, determine your placement as a volunteer.

Confidentiality Statement:

I agree to respect the confidential nature of all personal contact with consumers and adhere to all laws, rules, policies, and procedures pertaining to confidentiality regarding all records, files, and identifying information of consumers, former or potential, with whom I come into contact as a volunteer. I understand the violation of this confidentiality requirement can result in immediate dismissal from my volunteer assignment.

Affirmations *

I understand that this is an application and not a commitment or promise of a volunteer opportunity.
I certify that I have and will provide information on this application and in interviews that is true, correct, and complete to the best of my knowledge.
I understand Spectrum of Solutions will verify the information contained in my application.
I understand that misrepresentations or omissions may cause my immediate rejection as an applicant for a volunteer position or my termination as a volunteer with Spectrum of Solutions.
By signing this form, I give Spectrum of Solutions permission to verify any information provided in this application.
I give Spectrum of Solutions permission to perform a criminal background check.
If working with children under the age of 18, I will be in-serviced on Abuse and Neglect and Reporting Guidelines.
If the use of my vehicle is required, I will provide Spectrum of Solutions a copy of my automobile insurance.

I agree to adhere to all Spectrum of Solutions policies and procedures pertaining to my volunteer placement by my signature. A copy of the Volunteer Policy is included on the Spectrum of Solutions website. I affirm that the information on this application is accurate to the best of my knowledge.

Please read the above following carefully before signing this application.

Your Signature *

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Date / Time *

Volunteer Inquiry Disclosure *

I agree
I disagree

In connection with my application as a volunteer at Spectrum of Solutions, I understand that investigative inquiries on my background, per the Fair Credit Reporting Act and all state/federal laws, may be conducted. Including information about my character, abilities, work habits, mode of living, residency, immigration status, general reputation, performance, experience, and reasons for termination of past volunteer positions. I understand Spectrum of Solutions will make inquiries, including but not limited to: • Education • Driving History • Professional Licensing • Employment History • Nurse Aide Registry • Misconduct Registry • Criminal History • Med Aide Registry Furthermore, I understand that Spectrum of Solutions may request information from various federal, state, and other agencies that maintain records concerning my past criminal history, driving history, employment history, military history, civil and other matters. I understand that, according to the Fair Credit Reporting Act, I am entitled to know if my volunteer application is denied because of information obtained from a consumer reporting agency. Upon written request, I will be informed whether an investigative consumer report was requested and will be given information as to the nature and scope of this investigation and the name of the reporting agency or sources of information. I authorize, without reservation, all persons, and entities, including but not limited to businesses, former employers, law enforcement authorities, federal and state agencies, educational institutions, and private information bureaus or repositories contacted to furnish any or all of the above-mentioned information. In addition, I hereby release Spectrum of Solutions from any and all liability for damages arising from the investigation and disclosure of the requested information. I further release and discharge all liability from all companies, agencies, officials, officers, employees, and other persons who, in good faith, provide Spectrum of Solutions the above-mentioned information as requested in order to complete my background investigation successfully. I will allow a photocopy of this authorization to be as valid as the original.

Your Signature *

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Date / Time *

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Email: [email protected]

Call Anytime: (432) 695-9901

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Our Services

SPECTRUM OF SOLUTIONS
(432) 695-9901
2701 N. A Street
Midland, TX 79705

CHILDREN’S THERAPY CENTER
(432) 695-9913 | Therapies
2409 W. Illinois Street, Ste D
Midland, TX 79701

(432) 695-6682 | Psychology Services
2409 W. Illinois Street, Ste C
Midland, TX 79701

HELEN GREATHOUSE VOCATIONAL CENTER
(432) 695-9915
1101 South Street
Midland, TX 79701

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