Diamond In The Rough CROWNS College & Career Coaching Application

Thank you for your interest in Diamond In The Rough. Please complete the application below and submit it for consideration. Once submitted, our team will review your application and be in contact regarding the next steps. Please note, your information will be held in confidence.

Contact Information

Application Date +

First Name *

Last Name *

Maiden Name:

Address 1 *

Address 2

City *

State

Zip Code *

How long have you lived at the address above?

How long have you lived in Georgia?

Home Phone

Cell Phone *

Work Number:

Email Address *

Facebook Profile

Linkedin Profile

Instagram Profile

How were you referred to DITR? 🛈

Date of Birth *

SSN (used for background check)

Are you willing to pay a $20 administrative fee to help offset the cost of a criminal background check & liability insurance? *

Yes

No

Experience

Areas of Speciality *

BUSINESS CAREERS - Entrepreneurship, accounting, finance, human resources, attorney, marketing/pr, management, customer service, hospitality, logistics, etc.

CREATIVE CAREERS - Photography, graphic design, music, acting, authors, journalist, fashion designers, production, etc.

NON-TRADITIONAL CAREERS - Military, cosmetology, culinary arts, automotive, etc.

STEMS CAREERS - Science, medicine, pharmaceuticals, engineering, mathematics, architecture, aviation, CDC, etc.

SOCIAL AND HUMAN SERVICES CAREERS - Law enforcement, education, public service, nonprofits, church/clergy, early childhood politics, etc.

OTHER OTHER

Current Career Field: *

Years of Experience

Education/Degrees/Certifications

School/Institution

Other than a minor traffic violation, have you ever been arrested or convicted of any crime? *

No	Yes (if yes, please explain) Yes (if yes, please explain)

Are you or have you ever been the subject of a child abuse or mistreatment case or been penalized for mistreatment of a child? *

No	Yes (if yes, please explain) Yes (if yes, please explain)

Please describe the experience, skills, talents or qualities that make you a good candidate for this program (including former volunteer experience). *

Please list other organizations for which you have volunteered.

What concerns do you have regarding being a volunteer?

What do you hope to accomplish in being a volunteer? *

Please provide a statement of your faith. *

Please indicate the number of girls you are willing to be matched with? * 🛈

One girl

Two girls

Three girls

Employment History

Employer 1

Company Name *

Dates

Position(s)

Skills & Experience

Employer 2

Company Name

Dates

Position(s)

Skills & Experience

References

Reference 1

Name *

Email Address

Phone *

Reference 2

Name *

Email Address

Phone *

Reference 3

Name

Email Address

Phone

Emergency Contact

Name *

Relation *

Telephone *

Name

Relation

Telephone

Interest & Experience

Additional Skills & Experience

Please submit a copy of your resume (optional).

By submitting this application, I verify that all the information is accurate. I further, understand that as a part of the volunteer verification and matching process, additional personal information may be required of me including an interview with Diamond In The Rough professional staff. I certify that my statements in this application are true, complete and correct to the best of my knowledge. I hereby authorize Diamond In The Rough to contact the references listed and to conduct whatever investigation and background checks are necessary to determine if I will be a good fit for the organization. I understand that submitting this application does not guarantee my participation. I also hereby authorize Diamond In The Rough without limitation, to copy, publish, exhibit or distribute photographs or video tapes of my volunteer activities for the purpose of promoting volunteerism and support. I release and hold harmless from liability any person or organization that provides information. I also agree to hold harmless Diamond In The Rough and the officers, employees and volunteers thereof. *

I have read and agree to the statement above.