RMHC Michiana Volunteer Application

Contact information

Emergency Contact

In the event of an emergency whom should we notify?


Please include the name and phone number for a reference who is not a member of your family. 


Background Check Authorization

RMHC® of Michiana Background Check Policy 

It is the policy of RMHC of Michiana to conduct criminal background checks on volunteers/employees to ensure that the criminal history of the volunteer/employee does not include a conviction or guilty plea to a violent felony crime, sexual offense, or other felony within the past five years. Information obtained as a result of a criminal background check conducted by staff and/or staff delegates will be kept in strict confidentiality.


The following procedures for conducting criminal background checks on volunteers will apply:

  • Criminal histories will be checked on potential volunteer/employee prior to being scheduled to volunteer/employee.   Any potential volunteer/employee found to have a felony for a violent offense, sexual assault, crime against a child, murder, or sexual offender status will be excluded from volunteering or employment at RMHC of Michiana.  Persons with other felony convictions within the past three years will also be excluded.  Persons with misdemeanor convictions other than violent or sexual offenses will be permitted. Written notice of the refusal of a position will be given by the Director.
  • Additional criminal screening may be conducted if deemed necessary. 
  • Sex offender background checks will be conducted annually. 
  • The following websites may be used to conduct criminal history checks on volunteers:  NSOPW (Dru Sjodin National Public Sex Offender Registry)    www.nsopw.gov

Indiana Sex and Violent Offender Registry www.icrimewatch.net/indiana.php 

  • Background checks may be performed by RMHC of Michiana staff or third party vendors as defined by management. 
  • Current and potential volunteer/employee who refuse to consent to a criminal background check will be refused assignment by RMHC of Michiana.  Written notice of the refusal of a position will be provided.


By checking 'I Agree', I hereby voluntarily authorize and give consent to RMHC® of Michiana to obtain a personal background check. I understand this information will remain strictly confidential and available to me upon request.