Volunteer Application | CWS Lancaster

Your Contact Information
Name*
First Last
Address*
Street Address Address Line 2 City State ZIP Code
Email*
Enter Email Confirm Email
Phone*
Which office are you applying to volunteer with?*
- Lancaster
- Harrisburg

Your Availability and Schedule
Average number of hours per week you would like to volunteer*
Please enter a number from 1 to 40.
First Available Date*
MM slash DD slash YYYY
Your general schedule of availability
e.g. Monday AM, Tuesday PM, Friday PM

Your Connections
Are you part of a Welcome Team?*
- Yes
- No
Please indicate the name of the organization or faith group organizing the Team*
Are you volunteering to fulfill a class requirement or community service?
- No
- Yes
Please explain:
List any professional, civic, or organization that you belong to that you consider relevant to volunteering at CWS:
Emergency Contact Name*
First Last
Emergency Contact Relationship*
Emergency Contact Phone*

Processing and Statement of Consent
Volunteers are a vital part of achieving our goal of maintaining Lancaster as a welcoming community for refugees. We are thrilled to partner with you in this process!

Please understand that CWS-Lancaster takes the safety of our clients very seriously. You will be provided with more information on additional clearances and materials required to volunteer with CWS Lancaster, including materials required for compliance with the PA Child Protective Services Act. You will receive a follow-up email with instructions after completing this form.
AR-1 VOLUNTEER REQUEST FOR WAIVER OF FBI – FEDERAL CRIMINAL HISTORY FINGERPRINT RECORD CHECK
1. Please select the appropriate statement below:
1. Please select appropriate statement below:
- I have been a resident of the Commonwealth of Pennsylvania during the entirety of the previous ten-year period from the date of this document.
- I have NOT been a resident of the Commonwealth of Pennsylvania during the entirety of the previous ten-year period from the date of this document, and I will obtain a FBI finger-printed criminal background clearance.
2. I have NEVER been named as the perpetrator of a founded report of child abuse.
3. I have NEVER been convicted of any of the following types of offenses, including the attempt, solicitation or conspiracy to commit any of the following offenses:
a. Criminal homicide b. Aggravated assault c. Stalking d. Kidnapping e. Unlawful Restraint f. Rape g. Statutory sexual assault h. Sexual assault i. Involuntary deviate sexual intercourse j. Aggravated indecent assault k. Indecent assault l. Indecent exposure m. Incest n. Concealing the death of a child o. Endangering the welfare of a child p. Dealing in infant children q. Prostitution and related offenses r. Crimes related to obscene and other sexual materials and performances s. Corruption of minors t. Sexual abuse of children
4. Within the 5 year period immediately preceding the date of this document, I have not been convicted of a felony offense under The Controlled Substance, Drug, Device and Cosmetic Act; AND
5. I have not been convicted of an offense similar in nature to those crimes listed under paragraphs 2, 3 or 4 above under the laws or former laws of the United States or one of its territories or possessions, another state, the District of Columbia, the Commonwealth of Puerto Rico or a foreign nation, or under a former law Pennsylvania.
I understand that statements herein are made subject to the penalties of 18 Pa. C.S. § 4904 relating to unsworn falsification to authorities.
Print Name*
Date*
MM slash DD slash YYYY
Signature*
Phone
This field is for validation purposes and should be left unchanged.

CWS Lancaster Volunteer Application

Step 1 of 5

Your Contact Information

Your Skills and Interests

Your Availability and Schedule

Your Connections

Processing and Statement of Consent