VITA Volunteer Application

VITA Volunteer Application

Complete the entire volunteer application and make sure to submit.  If you are a new volunteer, you will also need to complete and submit the background check form.   Please note if you are a new volunteer we cannot consider your application without the background check form.

If you have any questions, please contact us at unitedway@kenoshaunitedway.org or call 262-658-4104.  

Thank you.

Please provide your first and last name
Please provide a phone number that we can contact you on. Do not add dashes or periods.
Please provide the first and last name of your emergency contact.
Please do not add dashes or periods.
If there are no languages outside of English you are comfortable speaking, please list None. If you speak a language other than English, you may be able to use those language skills as a VITA volunteer.
Please note that this is not a requirement to be a VITA volunteer.
I understand that in providing my services as a volunteer for the VITA program, I will respect the confidential nature of the knowledge I will gain concerning personal information of United Way of Kenosha County clients.
United Way of Kenosha County may take photographs or videos of participants, individually or in groups, attending or taking part in United Way programs and activities. These images, in original or modified form, may appear in future United Way publications and/or publicity, including print, web and video productions. Anyone who attends or participates in a United-Way-hosted event or activity authorizes the use and reproduction of any photographs taken during the event, without compensation by United Way. The opportunity or right to inspect or approve any such images or recordings is waived. If an individual does not wish to be photographed or videotaped, the person must notify the United Way staff to that effect. Permission for usage is assumed for any photographs submitted to United Way by an individual or organization. All images and files shall constitute United Way property, solely and completely.
I authorize the investigation of all statements contained herein and understand that any document relevant to this information may be reviewed by the agents of United Way of Kenosha County. I understand that I may not begin volunteering until the background investigation has been completed. I certify that the answers given by me in this disclosure statement are complete, true, and correct without misrepresentations or omissions of any kind. I further understand that the making of any false or misleading statement or omission from or on this disclosure, or any other document, will be used to deny me volunteer work, or, if currently volunteering, used to terminate my volunteer status. I consider the request for disclosure of pending charges and convictions ongoing and will notify United Way of Kenosha County of any changes to the statements contained herein. I understand that United Way of Kenosha County shall not be held liable in any respect if my volunteering is terminated because of false of incomplete statements, answers or omissions made by me on the disclosure form of any other document. In consideration of United Way of Kenosha County’s review of the document, I hereby release United Way of Kenosha County, its Board, its agents, as well as all providers of information from any liability and for any damage which may result from the furnishing and receiving of information. A copy of this authorization and release is as valid as the original and should be recognized as such.