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VIPS - Personal History Statement

  1. VIPS Logo.png

  2. Sachse Badge.png

  3. Are you willing to commit to at least 8 hours a month to the VIPS program?*

  4. I am currently:*

  5. You MUST provide three references

  6. All applicants will be subject to a criminal history check. Convictions or other criminal history may be relevant, but does not necessarily bar you from volunteering. If any questions is answered "YES" please include an explanation and include circumstances and dates where relevant.

  7. Have you ever been arrested, charged with, or received deferred adjudication for a criminal offense for any reason?*

  8. Are you presently under indictment or charged with a criminal offense, including DWI or DUI?*

  9. Are you, or have you ever been on probation or parole?*

  10. Has your driver's license ever been suspended, revoked, probated, or cancelled for any reason other than medical or disability reasons?*

  11. Have you ever used marijuana or any other illegal drug?*

  12. Have you ever used any legal drug not prescribed by a physician?*

  13. Have you sold, given, or delivered illegal drugs or narcotics to anyone?*

  14. Have you ever been present when others used, bought, or sold illegal drugs?*

  15. Are there any incidents (Positive or Negative) in your life or details not mentioned herein, which may influence this agency's evaluation of your application to volunteer?*

  16. Do you have any previous volunteering experience?*

  17. Please type your signature

  18. Leave This Blank:

  19. This field is not part of the form submission.