ITEM NUMBER: 7.28 a-c
CHAPTER 7: Administrative
Management
CODE: Information
COMPUTER ID: AMPER-9
Title: Volunteer Application Form
Effective Date: 8-1999
Authorized By: Library Board of Trustees/Library Director
Date of Last Revision: 6-2012
See next page for the Marathon County Public Library Volunteer Application Form.
Additional forms are kept at the Information Desk and also located in the Volunteer Office.
VOLUNTEER APPLICATION
MARATHON COUNTY
Check departments you wish to volunteer in:
Aging & Disability Resource Center Health Highway UW Extension
Parks/Recreation/Forestry
Library Social Services
Other _____________________ (Please identify)
Is this a service project for a youth group? Yes No
If yes, please indicate the following: # of hours ____________ By what date? ____________________
Personal Information:
Last Name _________________________ First ___________________ Middle _______________
Phone #__________________ Alternate #___________
___________________________________________________________________________________________
Address: Number/Street City State ZIP Code County
E-mail address:____________________________________________________________
Check education: High School
__________ College __________ Major __________
Special Training
Have you been known by a different name by any references, schools, or employers listed on this application?
Yes No If yes, indicate name: _______________________________________________________
Your birth date is needed to assist in completing criminal background checks required for positions:
Month __________ Day __________ Year __________
Have you ever been convicted of a crime? Yes No If so, when: ___________________________
Type of crime: _________________________________________________________________________
A conviction will not automatically disqualify a volunteer for a particular project. A volunteer may be rejected or
subsequently terminated if the circumstances of the arrest or conviction substantially relate to the assigned
volunteer duties.
Emergency Contact:
Who should we contact in case of emergency? Name: _________________________________________
Relationship: ____________________________ Phone #: ________________ Alternate #: ____________
Community Involvement Information: Complete the following where applicable. Please include service
organizations, professional groups, social groups, and church committees. Be sure to list any other volunteer experiences. (Attach additional sheets if necessary.)
Name of Organization City/State Dates Volunteer Duties
____________________ _________________ _____________ __________________________
____________________ _________________ _____________ __________________________
____________________ _________________ _____________ __________________________
Drivers Information (complete only if volunteering to drive)
Your driving information is needed to assist in completing a driving background check required for positions
involving transportation. Driving records must meet Marathon County standards.
Do you have a valid Wisconsin Yes No
________________________________________
(A photocopy of your drivers license is required)
A. Do you own or have access to an automobile? Yes No
List owner of vehicle: _____________________________________________________________
B. Please provide the following information for the vehicle you will be using for volunteer duties:
Make: _____________ Model: ________________Year: ____________
License Plate Number: _______________ Color: ____________ Number of Doors: ___________
C. This vehicle has properly functioning:
_____ headlights _____ seat belts _____ brakes _____ heater
_____ taillights _____ directional signals _____ windshield wipers
_____ properly inflated tires with a minimum of 1/8" tread
D. Auto Insurance Company: ____________________ Policy No. ________________
Policy Period _________ To _________
Insurance Agency: __________________________ Phone # _________________
Insurance
Automobile Insurance
Insurance verification is required when you will be performing driving duties as part of your volunteer assignment.
A photocopy of your auto policy declarations page is required and should be attached to the volunteer application.
At every renewal, a copy will be required to show proof of insurance. Auto liability limits must meet standard limits
required for volunteer drivers.
Reference Information:
Please list two references to contact who have knowledge of your qualifications.
Name: _______________________________ Relationship:____________________________________
Address: ______________________________________________________________________________
Number & Street City State Zip
Phone: (_____) ____________________ Fax Number: (_____) ___________________
Name: ______________________________ Relationship: __________________________
Address: ______________________________________________________________________________
Number & Street City State Zip
Phone: (_____) ____________________ Fax Number: (_____) ___________________
Read the following carefully before signing.
I certify that the information included in this application, or any other application materials submitted is true,
complete, and correct to the best of my knowledge and belief. I understand that any falsification or omission of
information may cause my immediate dismissal or no further consideration.
In some cases, I understand you may be investigating certain public information files for information relevant to my
application for volunteer service. This may include driving record information, licenses, or criminal history
information. I authorize you to obtain from any source regarding my education, experience competence, character
or medical history, as it relates to the volunteer position for which I applied.
I further acknowledge reading and understanding all of the provisions of this application and agree to comply to all
provisions if accepted as a Volunteer for Marathon County.
I understand that I may terminate my volunteer service at any time and that Marathon County may terminate my
volunteer service at any time.
_____________________________________ __________________________
Signature Date
_____________________________________ __________________________
Date
All volunteers must meet Marathon County volunteer standards
06/05/2012
CHAPTER 7: Administrative
Management
CODE: Information
COMPUTER ID: AMPER-9
Title: Volunteer Application Form
Effective Date: 8-1999
Authorized By: Library Board of Trustees/Library Director
Date of Last Revision: 6-2012
See next page for the Marathon County Public Library Volunteer Application Form.
Additional forms are kept at the Information Desk and also located in the Volunteer Office.
VOLUNTEER APPLICATION
MARATHON COUNTY
Check departments you wish to volunteer in:
Aging & Disability Resource Center Health Highway UW Extension
Parks/Recreation/Forestry
Library Social Services
Other _____________________ (Please identify)
Is this a service project for a youth group? Yes No
If yes, please indicate the following: # of hours ____________ By what date? ____________________
Personal Information:
Last Name _________________________ First ___________________ Middle _______________
Phone #__________________ Alternate #___________
___________________________________________________________________________________________
Address: Number/Street City State ZIP Code County
E-mail address:____________________________________________________________
Check education: High School
__________ College __________ Major __________
Special Training
Have you been known by a different name by any references, schools, or employers listed on this application?
Yes No If yes, indicate name: _______________________________________________________
Your birth date is needed to assist in completing criminal background checks required for positions:
Month __________ Day __________ Year __________
Have you ever been convicted of a crime? Yes No If so, when: ___________________________
Type of crime: _________________________________________________________________________
A conviction will not automatically disqualify a volunteer for a particular project. A volunteer may be rejected or
subsequently terminated if the circumstances of the arrest or conviction substantially relate to the assigned
volunteer duties.
Emergency Contact:
Who should we contact in case of emergency? Name: _________________________________________
Relationship: ____________________________ Phone #: ________________ Alternate #: ____________
Community Involvement Information: Complete the following where applicable. Please include service
organizations, professional groups, social groups, and church committees. Be sure to list any other volunteer experiences. (Attach additional sheets if necessary.)
Name of Organization City/State Dates Volunteer Duties
____________________ _________________ _____________ __________________________
____________________ _________________ _____________ __________________________
____________________ _________________ _____________ __________________________
Drivers Information (complete only if volunteering to drive)
Your driving information is needed to assist in completing a driving background check required for positions
involving transportation. Driving records must meet Marathon County standards.
Do you have a valid Wisconsin Yes No
________________________________________
(A photocopy of your drivers license is required)
A. Do you own or have access to an automobile? Yes No
List owner of vehicle: _____________________________________________________________
B. Please provide the following information for the vehicle you will be using for volunteer duties:
Make: _____________ Model: ________________Year: ____________
License Plate Number: _______________ Color: ____________ Number of Doors: ___________
C. This vehicle has properly functioning:
_____ headlights _____ seat belts _____ brakes _____ heater
_____ taillights _____ directional signals _____ windshield wipers
_____ properly inflated tires with a minimum of 1/8" tread
D. Auto Insurance Company: ____________________ Policy No. ________________
Policy Period _________ To _________
Insurance Agency: __________________________ Phone # _________________
Insurance
Automobile Insurance
Insurance verification is required when you will be performing driving duties as part of your volunteer assignment.
A photocopy of your auto policy declarations page is required and should be attached to the volunteer application.
At every renewal, a copy will be required to show proof of insurance. Auto liability limits must meet standard limits
required for volunteer drivers.
Reference Information:
Please list two references to contact who have knowledge of your qualifications.
Name: _______________________________ Relationship:____________________________________
Address: ______________________________________________________________________________
Number & Street City State Zip
Phone: (_____) ____________________ Fax Number: (_____) ___________________
Name: ______________________________ Relationship: __________________________
Address: ______________________________________________________________________________
Number & Street City State Zip
Phone: (_____) ____________________ Fax Number: (_____) ___________________
Read the following carefully before signing.
I certify that the information included in this application, or any other application materials submitted is true,
complete, and correct to the best of my knowledge and belief. I understand that any falsification or omission of
information may cause my immediate dismissal or no further consideration.
In some cases, I understand you may be investigating certain public information files for information relevant to my
application for volunteer service. This may include driving record information, licenses, or criminal history
information. I authorize you to obtain from any source regarding my education, experience competence, character
or medical history, as it relates to the volunteer position for which I applied.
I further acknowledge reading and understanding all of the provisions of this application and agree to comply to all
provisions if accepted as a Volunteer for Marathon County.
I understand that I may terminate my volunteer service at any time and that Marathon County may terminate my
volunteer service at any time.
_____________________________________ __________________________
Signature Date
_____________________________________ __________________________
Date
All volunteers must meet Marathon County volunteer standards
06/05/2012