Volunteer Application | City of New Albany

Name*

First Last

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone*

Email*

T-Shirt Size

City employee status or referral

If applicable, please state if you are a City employee and your job title or provide the name of the City employee or departemtn who referred you.

Personal Information

Date of Birth

Education

Highest Education:

Heard about volunteer program:

Employment Status

Prior Conviction? See Notes:

Yes
No

Major Degree

Driver's License

Name of employer or school

Location of employer or school

College name(s)

Availability

Morning

Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday

Afternoon

Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday

Evening

Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday

My availability is:

Ongoing
Flexible
Monthly
Occasionally
Summer
Weekends
Weekly

Please indicate which department you are most interested in.

About You

Are there any activities you don't like to do?

Please tell us about your interest and skills.

In case of emergency, contact . . . .

Name*

First Last

Phone*

Relationship*

Name*

First Last

Phone*

Relationship*

Criminal History

** HAVE YOU EVER BEEN CONVICTED OF A FELONY, MISDEMEANOR OR COURT MARTIAL? Some activities will be subject to a background check. List all convictions where you were sentenced and/or placed on probation after your 18th birthday. State the offense, date and name of court where convicted. A “yes” answer is not necessarily an automatic bar to placement, but failure to accurately disclose conviction information will disqualify you.

Specific volunteer interest & further information:

Please indicate specific volunteer opportunities or listings or types of activity that interest you. Describe any special skills, additional qualifications or certifications:

*

by checking this box, I agree to the Waiver & Release Agreement for the City of New Albany.