What are the Membership Liability Release issues?
PERSONAL, PROFESSIONAL OR VOLUNTEER REFERENCES
1. Name ________________________________________________
May we call? YES NO
Affiliation, Position or Relationship to You
_________________________________________
Home Phone __________________________ Work Phone ____________________________
2. Name ________________________________________________
May we call? YES NO
Affiliation, Position or Relationship to You
_________________________________________
Home Phone __________________________ Work Phone ____________________________
Omissions or misrepresentation of information on your application may
disqualify you from participation in the Timebank.
Affirmative answers to the following questions will not necessarily
disqualify an applicant from participation.
Are you currently on probation or parole? YES NO
If “yes” please describe the conviction and list the dates of
your probation:
_____________________________________________________________________________________________
Have you ever been convicted of a felony or do you have any pending felony
charges?
YES NO If “yes,” please describe
_________________________________________________________________________
