Appendix D

APPENDIX D

Morrisville Public Library Volunteer Application Form

Thank you for your interest in volunteering.  The information on this form will be used to help determine a volunteer assignment which will be well suited to your background and interests and availability.  Please complete all questions and sign the form before submitting.

Name_______________________________________________________     Date______________________________

Address______________________________________________________

City/State/Zip________________________________________________

Home Phone________________________

Work Phone________________________________________

Cell Phone_____________________________________

Age Group (circle one):  14-18     19-30     31-59     60+

You must be at least 14 to volunteer.  Volunteers under 18 must have a parent/guardian complete the consent section on the reverse side of this application.  Age if under 18______________

Do you have any medical conditions the library should be aware of? ________________________________________

_______________________________________________________________

Have you ever been convicted of a crime?   Yes_____  No_____

If yes, please give a short explanation outlining the circumstances of your conviction indicating date, nature and place of offense and disposition.  (Do not include traffic violations or convictions sealed or annulled by the court).  Convictions will not necessarily disqualify you from the volunteer position for which you are applying.

___________________________________________________________________

Occupation and/or Education:

Circle the highest grade completed 9, 10, 11, 12 College/Graduate School (degrees completed) ___________________

Current and/or former Occupation____________________________________________________________________

Employer______________________________________________________________________

Are you a student?      0Yes        0No

Which school do you attend? ________________________________________________________________________

References: List two employers, supervisors, teachers or non-relatives we may contact for reference.

Name_________________________________________________________  Phone____________________________

Name_________________________________________________________  Phone____________________________

Skills:

Do you know how to use a computer?     0Yes        0No

Are you familiar with:     0Internet        0Microsoft Word     0Microsoft Excel

What special interests and/or skills do you have that may help us match you with the best volunteer assignment?

____________________________________________________________________

Volunteer Interests:

Why do you want to volunteer?

__________________________________________________________________

Time Commitment:  Most volunteer positions at the library require an on-going commitment of 3-months or more.  Special projects may be available for less than a 3-month commitment.  Please tell us how long you would like to commit to a volunteer job.

03 months        06 months     09 months (a school year)        0One year      0On-going

0Summer (July 1-August 31)       0Other, please specify___________________________________________________

When are you available?  Please specify hours for all that apply.

Monday Tuesday Wednesday Thursday Friday Saturday
Morning Closed Closed Closed
Afternoon
Evening Closed

Please return completed application to the Library Manager, Morrisville Public Library, PO Box 37, Morrisville NY 13408

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