Runaway Assistance Program (R.A.P.)

Volunteer Application
Thank you for your interest in becoming a volunteer. As we expand our efforts we need more volunteers in every part of the Country.
Please fill out our Application and forward it back to us, as soon as possible.

Joe Mazzilli
Runaway Squad
Chairman-R.A.P.

Name(Last, First, Middle)

Address (Street, Apartment/Unit, City, State, Zip Code)

Aliases

E-mail Address

Location and Date of Birth

Social Security Number

Are you a U.S. Citizen?
 Yes No

Driver’s License?
 Yes No
License # State

Why do you wish to volunteer for R.S.?

Have you previously submitted an employment or volunteer application to R.S.?
 Yes No

If so, please indicate date(s) and position applied for

Law Enforcement Experience?
 Yes No
How many years?

Where?

Are you a Lawyer/Medical Professional?
 Yes No
How many years?

Where?

List any licenses, permits, certifications, special skills or other related items. (Please send copies of documents)

List three references (not related to you) who have known you for five years or more. (Name, Address, Phone Number)
1.
2.
3.
Have you ever been CONVICTED of a FELONY or MISDEMEANOR?
 Yes No

If YES, explain below

Date available to start volunteering for R.S.:
Month Day Year
Please indicate your approximate days and hours of availability.

# Hours per week

By signing the statement below, you certify that the information you have supplied us is true and correct to the best of your knowledge.
In the consideration of my application for a volunteer position with The Runaway Squad (R.S.): (1)1 hereby consent to being fingerprinted by a designated representative of a law-
enforcement agency for the purpose of R.S. obtaining information needed to determine my suitability for a volunteer position; (2) I hereby release (a) R.S., (b) any and all state and/or federal law-enforcement agencies that are involved in obtaining my fingerprints, and/or investigating my criminal record, and/or communicating results on the investigation to R.S., and (c) the representatives, employees, and agents of the aforementioned entities of any and all claims, actions, liabilities whatsoever arising from my being fingerprinted, investigated, and the results of the investigation being communicated to R.S..
Further, I agree to maintain the confidentiality of R.S.'s information including its clients, and I understand that any breach of this agreement could be detrimental to the recovery of a child and/or the prosecution of a case involving a missing or exploited child. R.S. is an "at will" employer, which means that this relationship is strictly voluntary. My relationship with R.S. can be ended by myself or R.S. with or without cause or notice, at any time.
I, the undersigned, authorize and consent to any person, firm, organization, or corporation provided a copy (including photocopy or facsimile copy) of this Authorization to release to the Runaway Squad any and all information or records requested by the Runaway Squad regarding my relationship to such person, firm, organization, or corporation including, but not necessarily limited to employment records, military records, criminal information records (if any), in connection with my application to be a volunteer for the Runaway Squad.
Any person, firm, organization, or corporation providing information or records in accordance with this Authorization is released from any and all claims or liability for compliance.