Have you ever been arrested or convicted of a criminal offense?
Have you ever been investigated, charged or convicted of child abuse, neglect or any other offense involving a child?
Have you ever been dismissed from any organization as a volunteer?
Highest educational level completed:
List the name and address of three individuals who are not related and have known you for five years or longer (please include complete mailing address)
I certify that the above information is correct. I also understand that a records check through the State Law Enforcement Division and the State Department of Social Services will be conducted on my application.