Annual Vintner Dinner
Children’s Literacy Circle
Volunteer to Tutor
CLC’s Wonderful Sponsors
Events & Happenings
Annual Report 2016
Download Character References and Background Check Application and make a $10 payment through Paypal
Part I - General Information
Date of Birth
How did you hear about Children's Literacy Center?
Part II - Demographics
Your answer to the following questions is optional and is only used for statistical purposes. Children's Literacy Center (CLC) is committed to avoiding discrimination in all its employment and service delivery practices including staff and volunteer recruitment, hiring, compensation, fringe benefits, staff development and training, promotion, termination, outreach and referral. CLC will not discriminate against persons because of sex, race, color, religion, class, national origin, age, political or union affiliation, marital status, or sexual orientation, and will not allow such protected status to hinder access to either employment or services delivered by CLC. Physical and mental handicaps will be considered only as they relate to bona fide paid or volunteer job requirements.
Part III - Limitations & Emergency Information
What health conditions, allergies or other limitations should we be made aware of?
Part IV - Education/Training/Volunteer Experience/Special Skills
Choose highest level of education completed
High School Diploma
List special skills, diplomas, certificates and degrees
Do you speak another language fluently?
Please list one other organization with which you have volunteered
Reason for volunteering
Desire for community involvment
Court ordered community service
Part V - Tutoring Sites
If you are completing this application to become a Peak Reader Tutor, please rank the locations below at which you would like to tutor in the order of preference with #1 being your first choice:
Barnes & Noble – Citadel
MLK Library – Aurora
Calvary United Methodist
Grant Library – Ft. Carson
Old Colorado City
If you have chosen to tutor at a site that has more than one time slot, which time is more convenient for you?
Which semester do you prefer to start?
Part VI - Background and Authorizations
Have you ever been convicted of a felony or a misdemeanor (other than minor traffic offenses)?
Please read and check each of the following statements if you agree:
I do hereby proclaim that I have never been convicted of or reported for abuse, neglect, sexual assault, or a related charge, against a child, as defined in the Colorado Revised Statutes. Furthermore, I am aware of the Colorado Revised Statute which states that intentionally/willfully placing a child in a position of danger, with intent to commit harm to said child, or placing child in a position of mistrust to include any sexual misconduct with a child, is punishable by law. I also understand that the Children's Literacy Center staff is required to report any such misconduct to the proper authorities. Such misconduct will be grounds for immediate suspension and possible prosecution and termination.
Throughout the year, Children's Literacy Center and local media publishes pictures and accounts of the activities and accomplishments of our students and volunteers. We would like to be able to include your picture in our media, but we also want to be sensitive to your privacy. Please indicate below if you give Children's Literacy Center permission to take your picture and include it and your name in any of our media.
Yes, I give permission to Children's Literacy Center to include my name and picture in any of their publications.
No, please do not publish my name or picture.
Release of Information
The information in my application is true and complete to the best of my knowledge. I understand that it is necessary for Children's Literacy Center to investigate my background and check my references. I hereby give my consent for this information exchange and authorize such agencies or individuals to release any information requested. I understand the agencies to be contacted shall include employers, character references, police (local, state or federal), Social Services and any other persons or agencies with which I have any interaction.
By submitting this form, I attest that the information I have provided on the form is true and accurate. I understand that an offer of volunteer work may be rescinded either before or after my date of assignment pending results received from my background check.
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