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Intern-Application-VC-Online Fillable File

  1. Visitation Center (JPG)
  2. Greene County Family Visitation Center

    143 East Market Street, Xenia, Ohio 45385


    Fax: (937) 562-5691


  3. Interns and Volunteers must have a willingness to help the children and families of Greene County, have good communication skills, and the ability to work well with children of all ages.
  4. I am interested in
  5. Please list three professional references (other than relatives). List individuals who have knowledge about your skills and abilities, such as; co-workers, a volunteer supervisor, a pastor, academic professional, etc.:
  6. Do you speak a foreign language?
  7. Have you ever been convicted of a crime, other than a traffic violation?
  8. Do you consent to a routine check of your criminal record (if necessary)?
  9. Have you lived in Ohio for the past 5 years?
  10. Have you been involved professionally or personally with the following programs/agencies?
  11. Children Services Board (CSB)?
  12. Foster Care?
  13. Court System?
  14. CASA?
  15. Other agencies offering services to children?
  16. Employment History (beginning with current):
  17. I certify that the statements herein contained are true to the best of my knowledge. I understand that any question contained herein, or failure to completely answer any question contained herein, is cause for dismissal from service to Greene County Visitation Center. I further understand that a record check with police agencies may be conducted as part of the application process, and I give Greene County Visitation Center permission to make such a check in order to ensure my suitability for volunteer placement.
  18. I understand and agree that Greene County Family Visitation Center may make a thorough investigation of my past employment and activities, and I release from liability or responsibility all persons and organizations supplying such information. I also understand and agree that the information obtained may be used by Greene County Family Visitation Center in any way connected with my involvement in the program.
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  20. This field is not part of the form submission.