(include organization names and dates of service)
[description of field, e.g., domestic violence, child abuse prevention, youth recreation, etc.]
I understand that this is an application for and not a commitment or promise of volunteer opportunity. I certify that I have and will provide information throughout the selection process, including on this application for a volunteer position and in interviews with CIES (formerly PSSofNC) that is true, correct, and complete to the best of my knowledge. I certify that I have and will answer all questions to the best of my ability and that I have not and will not withhold any information that would unfavorably affect my application for a volunteer position. I understand that information contained on my application will be verified by CIES. I understand that misrepresentations or omissions may be cause for my immediate rejection as an applicant for a volunteer position with CIES or my termination as a volunteer.