| ``CITY
Of DODGEVILLE PARKS AND RECREATION
DEPARTMENT |
| 100 E
Fountain St Dodgeville WI 53533 |
|
|
2008 Volunteer Application |
| Please circle which area of the
department you are submitting this application for: Parks
Recreation |
| Position(s) applied
for____________________________________________________________________ |
| Coaches promise 08.htm |
| PERSONAL- please print |
| ____________________________________________________________________________________________________ |
| Full Name (Last) (First) (Middle) |
| ____________________________________________________________________________________________________ |
| Address
(No. and Street)
(City and State)
(Zip) |
|
| Residence Telephone
No._________________________ Work
phone No. __________________________________ |
| E-mail
address:
________________________________________________________________________________________ |
|
| Please
provide below the name and phone number of person we should notify in case of
emergency: |
|
| Name________________________________Relationship________________________
Phone Number ___________________ |
|
|
| Date of Birth (mandatory for
background check)____________________________ |
|
| Sex (optional): Female______ Male______ |
|
| Are you at least 18 years
old? ________Yes ________No **If not, your employment will be subject to
verification that you |
| meet
state/federal minimum age requirements for the type of work you are applying
for and you will need to obtain a valid work permit for which you will be
reimbursed. |
|
| Have you ever been convicted or
pleaded no contest for any offense or violation other than minor traffic
violations? ________Yes ________ No. If yes, explain (1)
the nature of the offense or violation; (2) date of conviction, and (3) state
in which convicted. (Convictions are
not an automatic bar to employment.)__________________________________________________________ |
| ________________________________________________________________________________________________________________ |
|
| Do you have any pending criminal
charges against you? ________Yes ________No. If yes,
describe (1) the nature of charges; (2) date issued, and (3) county and state
where issued.
_______________________________________________________________ |
| ______________________________________________________________________________________________________ |
|
| In applying for volunteer hours, the
undersigned states that the above facts are correct to the best of his/her
knowledge and belief and that he/she is physically able to perform the work
assigned to him/her. |
|
| _________________________________________________ ________________________________ |
| Signature
Date |
|
| …………………………………………......................................Office
Use Only.....................................…………………………………. |
|
| Date
department received:_________________
Program volunteered for/session: ______________________ |
|
| Date check
completed: ____________________ Approved to volunteer:
_______________________ |
|
| Completed
by : __________________________ |
|