Name
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First Name
Last Name
Date of Birth
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MM
DD
YYYY
Phone
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(###)
###
####
Email
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Address
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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
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Name on Driver's License, State of Issue, and Number
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Has your driver's license been revoked or suspended within the past seven (7) years? If so, explain:
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For what volunteer position are you applying?
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Assembly Name/Number and/or District
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Do you have physical or health limitations which might limit your role in Rainbow activities?
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Have you used illegal drugs or been treated for a substance abuse problem in the past 7 years? If so, explain:
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Have you been convicted of any crime in the past seven (7) years? If so, explain:
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Occupation:
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Name and address of current employer:
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What skills, knowledge, and abilities could you contribute to Rainbow?
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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
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Have you ever been accused of physically, sexually, or emotionally abusing a child, youth, or adult? If yes, please explain
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Please provide references who have known you at least 7 years, two of whom are not affiliated with Rainbow. Reference #1
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Reference #2
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Reference #3
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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.
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Yes
No
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.
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Yes
No
With my electronic signature, I acknowledge and agree to the above information.
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