Adult Application and Profile

Full Adult Worker Profile (for new Board Members or Jr Board Members, new Certified Chaperones, or any adult workers who have had a change in their personal information since last year)

Have you completed this before and your information has not changed? Feel free to complete the information acknowledgement here

Name

First Name

Last Name

Date of Birth

YYYY

Phone

(###)

###

####

Assembly (Grand Deputies or people affiliated with more than one Assembly - please select one Assembly in your district)

For what volunteer position are you applying?

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

How long at current address? Please list all addresses and length of residence over past seven years

Name on Driver's License, State of Issue, and Number

Has your driver's license been revoked or suspended within the past seven (7) years? If so, explain:

Do you have physical or health limitations which might limit your role in Rainbow activities?

Have you used illegal drugs or been treated for a substance abuse problem in the past 7 years? If so, explain:

Have you been convicted of any crime in the past seven (7) years? If so, explain:

Occupation:

Name and address of current employer:

What skills, knowledge, and abilities could you contribute to Rainbow?

Masonic and Fraternal Membership (please itemize)

Are you a Majority Rainbow Girl? If so, please include Assembly Name and Number

Are you the Relative of a Rainbow Girl? If so please include the relation (parent, grandparent, etc)

Have you worked with other youth groups? If so please include, organization, dates of involvement, contact person and phone number, and your duties in the group

Has any adverse action been taken against you by any youth, church, scool, or day care center while you were an employee or volunteer? If yes, please explain

Have you ever been accused of physically, sexually, or emotionally abusing a child, youth, or adult? If yes, please explain

Please provide references who have known you at least 7 years, two of whom are not affiliated with Rainbow. Reference #1

Reference #2

Reference #3

To the best of my knowledge, the information contained in this application is complete and accurate. I understand that providing false information is grounds for not choosing me for a volunteer position. I authorize any person or organization, whether or not identified in this application, to provide any information concerning my personal, professional, criminal, driving, or other background qualifications pertaining to this application. I release, hold harmless, and agree to indemnify the International Order of the Rainbow for Girls, its Assemblies, Advisory Boards, and all other Rainbow bodies, organizations, sponsoring bodies, and their officers, employees, agents, and volunteers from any and all liability to me in connection with their good faith efforts to gather and use any information provided as a result of, or in connection with, this profile.

If chosen, I agree to be bound by the Code of Conduct, policies, and procedures of the International Order of the Rainbow for Girls. I understand that these may be modified at any time at the sole discretion of the International Order of the Rainbow for Girls without prior notice to me. I understand that, if there is concern about my responses, the Supreme Deputy will contact me directly.

With my electronic signature, I acknowledge and agree to the above information.