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Home
About Us
Our Leadership
Sponsors
Programs
Welcome to Womanhood
Welcome to Manhood
Emerging Leaders
CARES
Get Involved
Welcome to Manhood Mentee Application
Mentor Application
New Membership Application
Membership Payment
Media
Pictures
Videos
Newsletter
Contact Us
Donate
Volunteer
General Membership Application
Concerned Black Men of Los Angeles Membership Application
Step
1
of
4
25%
Name
*
First
Last
Phone
*
Email
*
Address
*
Street Address
Address Line 2
City
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
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Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
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Montana
Nebraska
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New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Why are you interested in volunteering?
*
Personal Interest
Educational Internship
Community Service Hours
Other
Is there a specific mentoring program in CBMLA you are interested in supporting?
*
Cares One on One Mentoring
Emerging Leaders
Welcome to Womanhood
Welcome to Manhood
Have you ever worked or do you currently work for CBMLA?
*
Yes
No
Have you ever received services from CBMLA?
*
Yes
No
Do you have a valid driver’s license?
*
Yes
No
Drivers License Number
*
Do you have a car available for use while volunteering?
*
Yes
No
Experience and Education
What is your educational/training background?
*
What is your employment history?
*
Have you had any previous experience as a volunteer? If so, with what organizations, and what kind of work did you do?
*
Does your current employer have (check all that apply):
Program for volunteering
Donation matching program
Grant preference to organizations where you volunteer
Your Interest at CBMLA
How did you learn about CBMLA?
*
Ad
Website
College/University
CBMLA Member/Volunteer
Facebook
Which opportunities do you wish to further explore?
How long can you commit to volunteering?
6 months or more
3-6 months
Occasionally
One time
What days are you available?
*
Mondays
Tuesdays
Wednesdays
Thursdays
Fridays
Saturdays
Sundays
What times are you available?
*
Mornings
Afternoons
Evenings
Do you prefer to work
Directly with people served
Behind the scenes
Computers
Maintenance
No preference
What are you hobbies/interests?
*
What skills would you like to use as a member or volunteer
*
Do you speak another language?
Yes
No
Please list the languages you speak fluently.
Do you have any special needs or restrictions we should be aware of?
*
Please describe in 3-5 sentences why you want to be a member or volunteer at CBMLA.
*
Why, at this particular time in your life have you chosen to volunteer with us? What do you hope to gain from being a volunteer?
Criminal History
Member and volunteer positions may require a Criminal History check. Conviction will not necessarily disqualify you from participating. Have you ever been convicted of a felony?  Yes  No If yes, explain.
*
Yes
No
Please explain:
*
Authorization Documents
AUTHORIZATION AND AGREEMENT BY APPLICANT
*
I certify that the facts set for in this volunteer application are true and complete to the best of my knowledge. I understand that any false statement, omission or misrepresentation in my application or placement interview may result in the rejection of my application or discharge from the volunteer program.
If required, I consent to having CBMLA complete a criminal background check prior to membership or volunteering.
If required, I agree to complete a drug screening and TB screening requirements relevant to the position for which I am applying
Concerned Black Men of Los Angeles considers applicants for membership/volunteering without regard to sex, race, age, religion, national origin, veteran or marital status, or any other legally protected status. We provide reasonable accommodation to qualified individuals with disabilities when it would not be an undue hardship. If you need a reasonable accommodation in the pre-placement process, please contact the President or Executive Director.
Name
*
First
Last
Date
*Writing your name in the above field affirms that you agree with the aforementioned statements.
While the vast majority of members/volunteers are not involved with alcohol abuse or illegal drugs, those who are can have an adverse impact on the workplace, as well as their own job performance. To meet our obligations, and to comply with our obligation under the Drug Free Workplace Act of 1988, the following policy has been adopted and will be enforced:
*
The organization prohibits the unlawful use, sale, possession, manufacture, distribution, or being under the influence of alcohol, drugs or any controlled substance, on organization property, in the presence of organization clients, while on duty, during rest periods and break periods, while operating an organization vehicle or attending an organization-sponsored event.
Members/Volunteers who violate this prohibition will be subject to disciplinary action, up to and including termination. Nothing in this policy restricts the organization’s right to terminate a member/volunteer at any time, with or without notice, for any reason not expressly prohibited by law.
The organization retains the right to require any members/volunteer to report for drug and/or alcohol testing for reasonable suspicion or following an accident in which there is injury to persons or damage to property.
Members/volunteers must abide by the terms of this statement and must notify the employer of any criminal drug conviction within five days of the conviction if workplace conduct is involved.
New members/volunteers will be required to report for drug testing after a placement offer has been made but before reporting for the assignment.
Name
*
First
Last
Date
I have read and understand the Drug Free Workplace Compliance Statement. I agree to comply with the CBMLA Drug and Alcohol Policy. I understand that any offer of placement with the Organization may be contingent upon the successful completion of drug testing before beginning assignment, and I consent to testing according to CBMLA policy.
References
Name of Reference #1
*
First
Last
Relationship
Phone
*
Email
*
Name of Reference #2
*
First
Last
Relationship
Phone
*
Email
*
Name of Reference #3
*
First
Last
Relationship
Phone
*
Email
*