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2. 
4. Volunteer Application Form
6. Volunteer Information
8. Date
   Date
9. First Name
10. Middle Name
11. Last Name
13. Birthdate
    Birthdate
14. Driver's License Number
15. Phone Number
16. EMail Address
18. Address
19. City
20. State
21. Zip Code
23. Race

    1. Alaska Native
    2. American Indian
    3. Black or African American
    4. Hispanic or Latino
    5. Native Hawaiian
    6. Other Pacific Islander
    7. White
24. Gender

    1. Male
    2. Female
25. Department/Agency Interested In
27. What Are Your Expectations As A Volunteer, And What Role(s) Would You Like To Participate In?
29. Education
31. Highest Grade Completed
32. High School Diploma Received?

    1. Yes
    2. No
33. Date Received
    Date Received
34. Post High School Education
36. Experience
38. Please List Any Experience And/Or Training Related To The Position. Please Include Any Affiliated Certifications/Organizations.
40. Health Information
42. Date Of Last Physical
    Date Of Last Physical
43. Emergency Contact Name
44. Phone Number
46. References

    Please list at least three (3) references, not related to you, who know your qualifications.

48. Name
49. Phone Number
50. Email Address
52. Address
53. City
54. State
55. Zip Code
57. Name
58. Phone Number
59. Email Address
61. Address
62. City
63. State
64. Zip Code
66. Name
67. Phone Number
68. Email Address
70. Address
71. City
72. State
73. Zip Code
75. Criminal History
77. Have You Ever Been Convicted Of A Criminal Offense, Including Moving Violations?

    1. Yes
    2. No
78. If Yes, Please Explain
80. Electronic Signature Agreement

    By checking the "I agree" box below, you agree and acknowledge that: 

    • 1) your submission will not be signed in the sense of a traditional paper document;
    • 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature; and 
    • 3) you may still be required to provide a traditional signature at a later date.

    Further, by checking the "I agree" box, you indicate that you give the department permission to conduct/request a background investigation, including a criminal and driving record check for possible criminal or traffic violations and license status.

    *If submission is for someone under the age of eighteen (18) a parent/legal guardian signature is required.

    1. I agree.
82. Electronic Signature*
83. Parent/Legal Guardian Electronic Signature
Leave This Blank:


85. 1. Receive an email copy of this form.
86. Email address

    This field is not part of the form submission.

87. Submit

* indicates a required field