WELCOME TO VOLUNTEER SERVICE

Size: px
Start display at page:

Download "WELCOME TO VOLUNTEER SERVICE"

Transcription

1 WELCOME TO VOLUNTEER SERVICE Dear New Volunteer, It is a sincere pleasure to welcome you to the Volunteer Service of Memorial Hermann Prevention and Recovery Center (PaRC). The men and women who volunteer their time play an important role in the day to day operations of the PaRC. Volunteers have the opportunity to make an impact on both patient areas and non-clinical areas as part of our team dedicated to providing the "Best of the Best" in service and care. The Memorial Hermann Healthcare System (MHHS) is the largest not-for-profit hospital system in Texas and tenth largest in the US. Our system includes 11 acute care hospitals, many outpatient and specialty clinics, and PaRC, Memorial Hermann's alcohol and drug treatment center. The program began at a psychiatric hospital in 1982, but was relocated and renamed the Memorial Hermann Prevention and Recovery Center (PaRC) in late The PaRC, then a 42-bed treatment center for adults, thrived in the new Texas Medical Center location and within 6 years had outgrown the building. With a full census and lengthy waiting list, the PaRC was relocated again, this time to a larger facility and campus. The new PaRC campus, located 3 miles north of 1-10 on Gessner Road, features 120 beds and offers detoxification, residential treatment, day and evening outpatient programs, Pain Recovery Program, a family program, and aftercare for adults. Moving from a 25,000 square foot building into newly renovated buildings with 140,000 square feet of space allowed the PaRC to expand services. An adolescent residential treatment program for teens ages 13 to 17 was opened in The PaRC has outpatient locations in Clear Lake, Cypress, Houston, Katy, Lake Houston, Lake Jackson, Pearland, Sugar Land and The Woodlands With a 29 year history of service excellence to the Houston community and beyond, the PaRC continues to bring its experience, depth, and expertise to the forefront of alcohol and drug treatment. Incorporating the newest medical approaches along with proven treatment models and methodologies, PaRC's clinical teams and the entire staff are dedicated to delivering exceptional patient care experiences on a daily basis. Thanks to persons like you, the Volunteer Service continues to grow and give invaluable service to the community. Sincerely, Matt Feehery, CEO [2 As of

2 VOLUNTEER APPLICATION - Personal Information It is our policy to keep this information confidential. Name: (First) (MI) (Last) of Birth: Social Security: Sex: M F Home Address: City: Zip Home Phone: Cell Phone: Name of Employer/Occupation: Business Address. City:.Zip: Are you a person in recovery? Yes No Are you alumni of the PaRC Yes No If yes, how long have you been clean and sober? How did hear about our Volunteer program Why do you want to volunteer with the recovery community? List Day(s) and Shift you can work regularly each week: (Office Assistance/Clerical) Sun Mon Tues Wed Thurs Fri Sat 9 am 12:30 pm 1:00 pm 5:00 pm Please circle the day you can work regularly each week: (Greenhouse) 11:30 am 2:30 pm Mon Wed Thurs Fri [3 As of

3 Please list two personal references: (long-time friend or for those in recovery, a 12 step sponsor) Name: Phone #: Address: City:,State: Zip: Name:.Phone #: Address:.City: State:.Zip: In case of an emergency, notify:. Relationship: Home Phone # Work# Do you have a relative working at this Memorial Hermann Hospital? YES NO If yes, give Name: Position: IN SUBMITTING THIS APPLICATION FOR MEMBERSHIP IN THE VOLUNTEER SERVICE OF MEMORIAL HERMANN PREVENTION AND RECOVERY CENTER (PaRC), I AM AWARE THAT SERVING AS A VOLUNTEER IS A PRIVILEGE CARRYING WITH IT HIGH TRUST AND RELATED OBLIGATIONS. I AGREE TO FULFILL MY SERVICE COMMITMENT AND TO CONFORM TO ALL RULES AND REGULATIONS OF THE VOLUNTEER SERVICE PROGRAM. Signature [4 As of

4 Have you ever been convicted of, or been on probation for, or deferred adjudication for, or are you awaiting trial for, or on probation for, or deferred adjudication for any felony or misdemeanor? YES NO If yes, please explain and give dates: Disposition: Court: Nature of Crime (Convictions will not necessarily disqualify an applicant- All facts and circumstances will be considered). I hereby certify that all the information contained on this application is true and complete. I authorize the Memorial Hermann Healthcare System to contact all sources necessary to verify this information and to check references as it may see fit. I understand that any misstatement or omission on this application is cause for loss of volunteer privileges. Signature MEDIA CONSENT: I,, hereby understand that my photograph may be taken for the purpose of promotion of services at Memorial Hermann Healthcare System which is deemed appropriate. I am aware I will not receive payment of any kind for my participation and grant Memorial Hermann Healthcare System the rights to use regardless of my future association with the facility and for an unrestricted time. Signature [5 As of

5 PRE-VOLUNTARY DISCLOSURE & RELEASE VOLUNTEER S FULL NAME Any Other Name You Have Volunteered Under: Social Security #.: of Birth: Current Address: City: State: Zip: Driver's License No.: State: Pursuant to the requirements of the Fair Credit Reporting Act, I acknowledge that a consumer report and/or investigative consumer report may be made in connection with my application for volunteering with prospective facilities. I understand that these investigative background inquiries may include credit, consumer, criminal, driving, prior volunteering and other reports. These reports may include information as to my character, work habits, performance and experience, along with reasons for termination of past volunteering from previous facilities. Further, I understand that agents may be requesting information from various Federal, State, and other agencies which maintain records concerning my past activities relating to my driving, criminal, civil and other experiences, as well as claims involving me in the files of insurance companies. I authorize, without reservation, any party or agency to furnish the above mentioned information. A photocopy of this authorization shall have the same effect as the original. I understand the information obtained will be used as one basis for volunteering or denial of volunteering. I hereby discharge, release and indemnify prospective school, their agents, servants and schools, and all parties that rely on this release and/or the information obtained with this release from any and all liability and claims arising by reason of the use of this release and dissemination of information that is false and untrue if obtained from a third party without verification. It is expressly understood that the information obtained through the use of this release will not be verified by investigating agents. The authorization granted herein expires one year from the date hereof. I have read and understood the above information, and asse1t that all information provided by me is true and accurate. If you are under the age of eighteen, the signature of a parent or guardian must be obtained. VOLUNTEER S SIGNATURE DATE: If you are denied voluntary, either wholly or partly because of information contained in a consumer report, a disclosure will be made to you of the name and address of the investigative agency making such report. Upon your written request within a reasonable period of time, the investigative agency compiling the report will make a complete and accurate disclosure of the nature and scope of the investigation. 1 A consumer report may consist of enrollment records, educational verification, licensure verification, driving record, previous address and public records relative to criminal charges. 2 An "Investigative Consumer Report" means a consumer report or portion thereof in which information on a consumer's character, general reputation, personal characteristics, or mode of living is obtained through personal interviews with persons having knowledge.

6 Volunteer Program Guidelines Requirements/Restrictions Must be 18 years or older. If a PaRC alumni, for Office Assistant/Clerical volunteer positions must be one year sober and a graduate of Aftercare. If a PaRC alumni, for Greenhouse volunteer program must be 6 months sober and provide weekly signed form from Aftercare coordinator. If in recovery from another program, must be 18 months sober, actively working in a recovery program and provide a letter from your sponsor. Pass a background check, TB test and have flu shot. Participate in Orientation. Commit to one year and at least 3 hours per week. Adhere to dress code of business casual no jeans. Be on time to your shift. Notify staff if you leave your station Volunteers who are going to be late or unable to work their shift must contact the Volunteer Coordinator in advance of their absence. Smile, make eye contact and treat everyone with dignity and respect. Direct patients, family members and visitors as needed. If patients, family members or visitors have questions you cannot answer, please contact a staff member Greenhouse volunteers must notify Greenhouse Coordinator or Volunteer Coordinator if they were in treatment with a patient currently in the Greenhouse program. Do not read a patient's chart under any circumstances. Do not give medications to patients including non prescription or over the counter medicines. Do not give food or drink to patients unless approved by staff. Do not be discourteous to a patient, family members or visitors. If someone does something or says something that is offensive to you, do not respond in kind; report it to a staff member. Do not run errands, buy cigarettes, and give money, offer transportation or housing to any patient, family member or visitor Do not give address or phone number to patients, family members or visitors. Volunteers will not engage in a romantic, sexual or business relationship with a patient or family member. Violation results in immediate dismissal. Do not ask Doctors or Nurses for professional or medical advice. Volunteers will be asked to leave the Volunteer program if he/she cannot abide by these guidelines. Volunteer

7 Memorial Hermann Healthcare System Volunteer Confidentiality Agreement IMPORTANT: Please read all sections. If you have any questions, please ask before signing. 1. Confidentiality of Patient Information As a hospital Volunteer, I understand and acknowledge that: (i) services provided to patients are private and confidential; (ii) to enable such services to be performed, patients provide personal information with the expectation that it will be kept confidential and used only by authorized persons as necessary; (iii) all personally identifiable information provided by patients or regarding medical services provided to patients, in whatever form such information may exist, including oral, written, printed, photographic and electronic formats (collectively, the "Confidential information") is strictly confidential and is protected by federal and state laws and regulations that prohibit its unauthorized use or disclosure; and (iv) in the course of my volunteer activities with Memorial Hermann Healthcare System, I may see or learn of Confidential Information. 2. Disclosure, Use and Access I agree that, except as authorized in connection with my volunteer assignment, I will not at any time use, access or disclose any confidential information to any person (including but not limited to other volunteers, friends and family members). I understand that this obligation remains in full force during the entire period of my volunteer activities and continues in effect after my volunteer activities. 3. Confidentiality Policies I agree that, even though I am a volunteer, I must and will comply with the same confidentiality policies that apply to all staff at the hospitals(s). 4. Return of Confidential Information At the end of my volunteer work, or at any other time upon request, I agree to promptly return to Memorial Hermann Healthcare System all copies of any Confidential Information then in my possession or control (including all printed and electronic copies). 5. Periodic Certification I understand that I am required to provide a written certification each year that I have complied in all respects with this Agreement. Such written certification will be on a form provided by Memorial Hermann. 6. Requirement I understand that my agreement to abide by the confidentiality policies, and this Agreement, is a condition of my volunteer activities with Memorial Hermann. I understand that failure to comply with confidentiality policies will result in my no longer being accepted for volunteer activities. Signature Printed Name

8 VOLUNTEER PROGRAM PROOF OF PPD (Purified Protein Derivative) Test (also known as TB Test) and FLU SHOT skin test given Site test given: Right arm Left arm Test administered by result read: Result: Negative Positive Result read by Comments, if any FLU SHOT VERIFICATION ADMININSTERED BY (Signature) (Please print full name) TB Tests and Flu Shots are administered free of charge at Memorial Hermann Memorial City by the Occupational Health nurse. Please call to schedule an appointment.

9 THE VOLUNTEER CODE OF ETHICS THE VOLUNTEER IS RESPONSIBLE Serving as a Volunteer is a privilege carrying high trust and related obligations. THE VOLUNTEER IS ETHICAL The Volunteer is expected to conform to the same high standards of behavior as the professional staff of the hospital. THE VOLUNTEER IS LOYAL When evaluated objectively, the conduct of the Volunteer is consistent with and promotes the best interests of the patients, the staff and the hospital. THE VOLUNTEER IS DISCREET The Volunteer holds in deep respect the doctor-patient-hospital relationship and protects the confidential nature of all privileged information to which there may be access. THE VOLUNTEER IS DISCIPLINED Aware of the functions inherent in the Volunteer Role, the Volunteer serves patients and visitors. In addition, the Volunteer is sensitive to the restrictions of his/her position and refers medical questions, religious matters, hospital policy and business affairs to the appropriate authority. THE VOLUNTEER IS OBJECTIVE The Volunteer exercises tolerance and respect for all persons different from self and for those who hold viewpoints different from those the Volunteer endorses. The Volunteer avoids controversial discussions with patients and staff. THE VOLUNTEER IS CONSTRUCTIVE Criticism or other information affecting the patient, staff, Volunteer Service or hospital is handled by relaying it only to the Department of Volunteer Services for proper referral. THE VOLUNTEER IS SELFLESS In giving service for the public good, the Volunteer does not seek medical advice or special privileges derived from his/her unique relationship to the hospital.

WELCOME TO VOLUNTEER SERVICE

WELCOME TO VOLUNTEER SERVICE WELCOME TO VOLUNTEER SERVICE Prevention & Recovery Center Dear New Volunteer, It is a sincere pleasure to welcome you to the Volunteer Service of Memorial Hermann Prevention and Recovery Center (PaRC).

More information

JUNIOR VOLUNTEER SERVICE

JUNIOR VOLUNTEER SERVICE Application is due by April 30 th. Interviews conclude May 18 th Selections made May 31 st Program begins June 4 th Program concludes July 31 st JUNIOR VOLUNTEER SERVICE Thank you for inquiring about the

More information

POLICY NO Volunteer Policy (Replaces Policy Adopted 12/13/2011)

POLICY NO Volunteer Policy (Replaces Policy Adopted 12/13/2011) POLICY NO. 28-01 Volunteer Policy (Replaces Policy Adopted 12/13/2011) Policy Statement Hernando County recognizes that volunteers are essential to the productivity, efficiency and cost effectiveness of

More information

POLICY NO Volunteer Policy (Replaces Policy Adopted 1/26/1998)

POLICY NO Volunteer Policy (Replaces Policy Adopted 1/26/1998) POLICY NO. 28-01 Volunteer Policy (Replaces Policy Adopted 1/26/1998) Policy Statement Hernando County recognizes that volunteers are essential to the productivity, efficiency and cost effectiveness of

More information

The Marion County Sheriff s Office

The Marion County Sheriff s Office The Marion County Sheriff s Office Application Position: (Circle all that apply) Deputy Sheriff Dispatcher Auxiliary Deputy Other Part time Full Time MARION COUNTY SHERIFF S OFFICE EMPLOYMENT OR AUXILIARY

More information

VOLUNTEER APPLICATION

VOLUNTEER APPLICATION Thank you for your interest in Estes Park Medical Center. The mission of the Estes Park Medical Center is to make a positive difference in the health and wellbeing of all we serve. VOLUNTEER APPLICATION

More information

Volunteer Application

Volunteer Application Volunteer Application Applicant Information First Name: Middle Initial: Last Name: Address: City: State: Zip: Home Phone: Cell Phone: Email: Occupation: Special Skills: Volunteer Preferences Have you previously

More information

North Hawaii Community Hospital Volunteer Services Application

North Hawaii Community Hospital Volunteer Services Application North Hawaii Community Hospital Volunteer Services Application Today s Date: Name: Address: City/State/Zip: Home Phone: Business Phone: Social Security #: Birth Date: Are you 18 years of age or older?

More information

Crandall Fire Department

Crandall Fire Department Crandall Fire Department Membership Application Today s Date Please Print or Type all information. All printing must be in BLUE ink. Omissions and/or false information are cause for rejection or dismissal.

More information

SHERIFF OF GARFIELD COUNTY LOU VALLARIO

SHERIFF OF GARFIELD COUNTY LOU VALLARIO SHERIFF OF GARFIELD COUNTY LOU VALLARIO 107 8 TH Street Glenwood Springs, CO 81601 Phone: 970-945-0453 Fax: 970-945-7700 106 County Road 333-A Rifle, CO 81650 Phone: 970-665-0200 Fax: 970-665-0253 Dear

More information

TWUMC APPLICATION FOR EMPLOYMENT PRE-EMPLOYMENT QUESTIONAIRE All questions must be answered completely with or without a resume.

TWUMC APPLICATION FOR EMPLOYMENT PRE-EMPLOYMENT QUESTIONAIRE All questions must be answered completely with or without a resume. TWUMC APPLICATION FOR EMPLOYMENT PRE-EMPLOYMENT QUESTIONAIRE All questions must be answered completely with or without a resume. Applicant Information Position Applied For: Are you employed now? Yes (

More information

We are delighted that you have expressed an interest in becoming a volunteer at Bryn Mawr Hospital!

We are delighted that you have expressed an interest in becoming a volunteer at Bryn Mawr Hospital! Dear Community Member: We are delighted that you have expressed an interest in becoming a volunteer at Bryn Mawr Hospital! Volunteers are our most valuable asset, performing a variety of non-medical services

More information

Children s Hospital Los Angeles Application for Summer Junior Volunteer Program 2018 (15-17 years of age)

Children s Hospital Los Angeles Application for Summer Junior Volunteer Program 2018 (15-17 years of age) Children s Hospital Los Angeles Application for Summer Junior Volunteer Program 2018 (15-17 years of age) Dear Volunteer Applicant: Thank you for your interest in becoming a Junior Volunteer at Children

More information

Legislative Administration Office Only. Last First Middle Are you known by other names while previously employed? YES NO.

Legislative Administration Office Only. Last First Middle Are you known by other names while previously employed? YES NO. Tohono O odham Nation Legislative Branch P.O. Box 837 Sells, Arizona 85634 Phone: (520) 383-2470 (520) 383-5260 Fax: (520) 383-2479 Website: www.tolc-nsn.org Legislative Administration Office Only Date

More information

Rutherford Co. Rescue

Rutherford Co. Rescue RCLAFA, INC. Rutherford Co. Rescue Application You are only allowed to check one that you are applying for: Reserve Status Specialty Rescue Team Part-Time Paid Employee This application must be completely

More information

EMPLOYEE FILES. Applying for the Job

EMPLOYEE FILES. Applying for the Job EMPLOYEE FILES Applying for the Job 1 Assisted Living Center at Sendera Ranch 5406 Ranch Lake Dr Magnolia, Texas 77354 281.804.6182 Phone 936.441.8185 Fax alcsenderaranch@gmail.com email APPLICATION FOR

More information

Thank you for your interest in helping to bring smiles to children with a life threatening illness and their families.

Thank you for your interest in helping to bring smiles to children with a life threatening illness and their families. A retreat for children with life-threatening illnesses and their families Dear Friend, Thank you for your interest in helping to bring smiles to children with a life threatening illness and their families.

More information

AMHERST COUNTY SHERIFF'S OFFICE An equal opportunity employer Women and Minorities are encouraged to apply.

AMHERST COUNTY SHERIFF'S OFFICE An equal opportunity employer Women and Minorities are encouraged to apply. An equal opportunity employer Women and Minorities are encouraged to apply. Sheriff E.W. Viar Jr. P.O. BOX 410, 115 TAYLOR STREET, AMHERST, VIRGINIA 24521 BUSINESS 434.946.9381 ~ ADMINISTRATION 434.946.9301

More information

REFERENCES: (If applying to assist with religious activities, please include a member of the clergy as a reference.)

REFERENCES: (If applying to assist with religious activities, please include a member of the clergy as a reference.) BRRJA APPLICATION FOR VOLUNTEER SERVICES SITE: AA NA Academic Religious Other DATE: FULL NAME: Last First Middle HOME ADDRESS: Street City State Zip PHONE: Home Cell Work EMAIL ADDRESS: EDUCATION: HS Degree

More information

EMPLOYMENT PROCEDURES FOR SUBSTITUTE TEACHING STAFF

EMPLOYMENT PROCEDURES FOR SUBSTITUTE TEACHING STAFF EMPLOYMENT PROCEDURES FOR SUBSTITUTE TEACHING STAFF PHASE I 1. Secure application form in person, mail, telephone, or website (www.pittsville.k12.wi.us). 2. Return the completed application form with a

More information

SUMMER INTENSIVE RESIDENT ASSISTANT APPLICATION PACKET

SUMMER INTENSIVE RESIDENT ASSISTANT APPLICATION PACKET SUMMER INTENSIVE RESIDENT ASSISTANT APPLICATION PACKET Dear Applicant, Thank you for your interest in the Milwaukee Ballet Summer Intensive Resident Assistant Position. Resumes will be collected until

More information

APPLICATION FOR VOLUNTEER SERVICE Lone Star College-CyFair Branch Library

APPLICATION FOR VOLUNTEER SERVICE Lone Star College-CyFair Branch Library APPLICATION FOR VOLUNTEER SERVICE Lone Star College-CyFair Branch Library Personal Information Name: Address: City: Telephone: Email: Best time to contact you: Alt. Telephone: Age (if under 18 years):

More information

Bonnie Butler-Sibbald. Dear Volunteer Applicant:

Bonnie Butler-Sibbald. Dear Volunteer Applicant: VOLUNTEER SERVICES Telephone (818) 409-7781 Facsimile Dear Volunteer Applicant: Thank you for your interest in the volunteer opportunities at Glendale Memorial Hospital and Health Center (GMHHC). Please

More information

2. Once you have completed your application form, we require two (2) non-family members to complete a reference form for you (see attached).

2. Once you have completed your application form, we require two (2) non-family members to complete a reference form for you (see attached). Volunteer Services Thank you for your interest in volunteering and in serving the patients and families of DeKalb Medical. Listed below are the steps in our application process: 1. Fill out our application

More information

Roosevelt Care Center. Volunteer Service Application

Roosevelt Care Center. Volunteer Service Application Volunteer Service Application Name : : City, State, Zip Code: Home phone #: Cell phone# In Case of Emergency, please notify: Phone # Relationship: of last PPD (Tuberculosis skin test) Have you had: Mumps

More information

Hillsborough County Fire Rescue Reserve Responder Program 9450 E Columbus Ave Tampa, FL Office: Fax:

Hillsborough County Fire Rescue Reserve Responder Program 9450 E Columbus Ave Tampa, FL Office: Fax: Application For Reserve Responder Full Name: Last First M.I. Date Submitted: Street Address Apartment/Unit # City State ZIP Code Email Name As It Appears On Driver s License: Driver s License #: State

More information

CODAC BEHAVIORAL HEALTH SERVICES, INC.

CODAC BEHAVIORAL HEALTH SERVICES, INC. CODAC BEHAVIORAL HEALTH SERVICES, INC. Human Resources 1650 East Ft. Lowell Rd. Suite 202 Tucson, Arizona 85719 Administration: 520 327 4505 Human Resources: 520 202 1890 Fax: 520 202 1718 Website: www.codac.org

More information

PLEASE TYPE OR PRINT CLEARLY USING A PEN. Today s Date:

PLEASE TYPE OR PRINT CLEARLY USING A PEN. Today s Date: Name: Previous Name/s: Home Phone No: Work Phone No: E-mail: What class of Administrative Certificate do you hold? PLEASE TYPE OR PRINT CLEARLY USING A PEN Today s Date: If you do not possess an administrative

More information

VOLUNTEER SERVICES APPLICATION (Must be 16 years of age or older.)

VOLUNTEER SERVICES APPLICATION (Must be 16 years of age or older.) Please Indicate Volunteer Location: St. Charles Bend St. Charles Madras 2500 NE Neff Road 470 NE A Street Bend, OR 97701 Madras, OR 97741 St. Charles Redmond St. Charles Prineville 1253 NW Canal Blvd.

More information

3. Once you have completed your application form, we require two (2) non-family members to complete a reference form for you (see attached).

3. Once you have completed your application form, we require two (2) non-family members to complete a reference form for you (see attached). Volunteer Services Thank you for your interest in volunteering and in serving the patients and families of DeKalb Medical. Listed below are the steps in our application process: 1. Fill out our application

More information

COUNTY OF YOLO OFFICE OF THE DISTRICT ATTORNEY JEFF W. REISIG, DISTRICT ATTORNEY CITIZENS ACADEMY APPLICATION PROCESS

COUNTY OF YOLO OFFICE OF THE DISTRICT ATTORNEY JEFF W. REISIG, DISTRICT ATTORNEY CITIZENS ACADEMY APPLICATION PROCESS COUNTY OF YOLO OFFICE OF THE DISTRICT ATTORNEY JEFF W. REISIG, DISTRICT ATTORNEY CITIZENS ACADEMY APPLICATION PROCESS Please complete and return the following forms. You may fill the forms out online,

More information

Junior Volunteer Program

Junior Volunteer Program 5126 Hospital Drive Covington, GA 30014 Tel: 770.788.6553 Andrea.Lane@piedmont.org Junior Volunteer Program Information Packet Piedmont Newton Hospital Volunteer Services Summer 2016 June 13 July 22 1

More information

bring it with you to your scheduled interview (do not submit this with your application);

bring it with you to your scheduled interview (do not submit this with your application); Dear Volunteer Applicant: Thank you for your interest in the Volunteer Services program at Carolinas HealthCare System Lincoln. Joining the dedicated team of adult and teen volunteers can be a richly rewarding

More information

Sign and return included forms. (Authorization to Release Information Form, Background Check Form and Vehicle Use Agreement)

Sign and return included forms. (Authorization to Release Information Form, Background Check Form and Vehicle Use Agreement) To: Employees with Conditional Offers of Employment Re: Background Checks All offers of employment or participation in any activity involving minors in a University sponsored program with The University

More information

Washington County Tennessee Sheriff s Office. Ed Graybeal, Sheriff. Employment Application Packet

Washington County Tennessee Sheriff s Office. Ed Graybeal, Sheriff. Employment Application Packet Washington County Tennessee Sheriff s Office Ed Graybeal, Sheriff Employment Application Packet PLEASE READ CAREFULLY AND ANSWER ALL QUESTIONS COMPLETELY. INCLUDE A COPY OF YOUR DRIVER S LICENSE, BIRTH

More information

COUNTY OF SAN BERNARDINO Office of the District Attorney

COUNTY OF SAN BERNARDINO Office of the District Attorney APPLICATION PACKAGE GENERAL VOLUNTEER PROGRAM If you are interested in becoming a General Volunteer at the San Bernardino County District Attorney s Office, please complete this application and mail the

More information

GENERAL APPLICATION FOR EMPLOYMENT Human Resources City of New Smyrna Beach 210 Sams Avenue New Smyrna Beach, Florida 32168

GENERAL APPLICATION FOR EMPLOYMENT Human Resources City of New Smyrna Beach 210 Sams Avenue New Smyrna Beach, Florida 32168 GENERAL APPLICATION FOR EMPLOYMENT Human Resources City of New Smyrna Beach 210 Sams Avenue New Smyrna Beach, Florida 32168 PLEASE PRINT OR TYPE Date of Application Position(s) Applied For The City of

More information

VOLUNTEER APPLICATION

VOLUNTEER APPLICATION VOLUNTEER APPLICATION Name: Age: Date of Birth: Social Security : Address: City: State: Zip Phone: Work: Cell: Email Address: How can we reach you? Home phone Cell phone Text Email Work phone Employer/School:

More information

Midland College Bachelor of Applied Science Health Services Management Program Application for Admission

Midland College Bachelor of Applied Science Health Services Management Program Application for Admission Midland College Bachelor of Applied Science Health Services Management Program Application for Admission Students should first complete the Midland College application at www.applytexas.org if not already

More information

EMPLOYMENT PROCEDURES FOR PARAPROFESSIONAL STAFF

EMPLOYMENT PROCEDURES FOR PARAPROFESSIONAL STAFF EMPLOYMENT PROCEDURES FOR PARAPROFESSIONAL STAFF PHASE I 1. Secure application form in person, mail, telephone, or website (www.pittsville.k12.wi.us). 2. Return the completed application form with a copy

More information

Name of Sex: M F Applicant: Last First Middle. Date of Birth: Social Security Number: Phone: ( ) City State Zip. Phone: ( ) City State Zip

Name of Sex: M F Applicant: Last First Middle. Date of Birth: Social Security Number: Phone: ( ) City State Zip. Phone: ( ) City State Zip SCHNEIDER REGIONAL MEDICAL CENTER 9048 SUGAR ESTATE ST. THOMAS, U.S.V.I 00802 APPLICATION FOR TEMPORARY PRIVILEGES (USED FOR URGENT PATIENT NEED AND LOCUM TENENS) COMPLETE THE APPLICATION IN FULL. PRINT

More information

If you have any questions, please direct them to the District Volunteer Office at (916)

If you have any questions, please direct them to the District Volunteer Office at (916) Dear Volunteer, We are pleased that you have decided to participate in the Sacramento City Unified School District (SCUSD) Volunteer Program! As parents, grandparents, neighbors and community members you

More information

EMPLOYMENT APPLICATION & INSTRUCTIONS

EMPLOYMENT APPLICATION & INSTRUCTIONS EMPLOYMENT APPLICATION & INSTRUCTIONS An Equal Opportunity Employer Lander County Sheriff s Office P.O. Box 1625, Battle Mountain, NV 89820 (775) 635-1100 ~~ FAX (775) 635-2577 If you believe you require

More information

CREDENTIALING APPLICATION Please complete all sections. Incomplete applications may delay the credentialing process.

CREDENTIALING APPLICATION Please complete all sections. Incomplete applications may delay the credentialing process. CREDENTIALING APPLICATION Please complete all sections. Incomplete applications may delay the credentialing process. PERSONAL IDENTIFICATION DATA Last Name: First: MI: Degree: Date of Birth: Social Security

More information

Volunteer Application Packet

Volunteer Application Packet Volunteer Application Packet 6560 Poplar Avenue, Suite B Memphis, TN 38138 P: (901) 767-8511 F: (901) 763-2348 www.jfsmemphis.org www.jccmemphis.org Please fill out pages 5-8 completely and return. Please

More information

APPLICATION FOR VOLUNTEERISM

APPLICATION FOR VOLUNTEERISM APPLICATION FOR VOLUNTEERISM Carolinas HealthCare System Blue Ridge ensures all applicants equal opportunity and consideration for volunteerism and does not discriminate on the basis of age, race, color,

More information

We are excited to help you through the process to become a volunteer here at Northside Hospital Cherokee and look forward to meeting you soon.

We are excited to help you through the process to become a volunteer here at Northside Hospital Cherokee and look forward to meeting you soon. Dear Prospective Volunteer: Thank you for your interest in the volunteer program at Northside Hospital Cherokee. We are proud of the volunteer services here at Northside Cherokee. Our members come from

More information

Rockton Fire Protection District. Application for Membership

Rockton Fire Protection District. Application for Membership Rockton Fire Protection District Application for Membership 1 Rockton Fire Protection District Mission Statement The Rockton Fire Protection District is dedicated to protecting the lives and property of

More information

State of Florida Department of Health. Board of Osteopathic Medicine. Application for Registration as an Osteopathic Physician in Training

State of Florida Department of Health. Board of Osteopathic Medicine. Application for Registration as an Osteopathic Physician in Training State of Florida Department of Health Board of Osteopathic Medicine Application for Registration as an Osteopathic Physician in Training Board of Osteopathic Medicine 4052 Bald Cypress Way, #C-06 Tallahassee,

More information

City of Pigeon Forge Police Department. Position: The City of Pigeon Forge Police Department is accepting applications for Communications Officer.

City of Pigeon Forge Police Department. Position: The City of Pigeon Forge Police Department is accepting applications for Communications Officer. City of Pigeon Forge Police Department Position: The City of Pigeon Forge Police Department is accepting applications for Communications Officer. Qualifications: Must be at least eighteen years of age

More information

Sign and return included forms. (Background Check Form, Authorization to Release Information Form, and Vehicle Use Agreement)

Sign and return included forms. (Background Check Form, Authorization to Release Information Form, and Vehicle Use Agreement) To: Employees with Conditional Offers of Employment Re: Background Checks All offers of employment or participation in any activity involving minors in a University sponsored program with The University

More information

COMPEER PROGRAM VOLUNTEER APPLICATION

COMPEER PROGRAM VOLUNTEER APPLICATION Spreading Hope, Spurring Action, Supporting Families, Saving Lives! COMPEER PROGRAM VOLUNTEER APPLICATION 3701 Latrobe Drive, Suite 140 Charlotte, NC 28211 Phone 704.365.3454 Fax 704.365.9973 Revised 7/13/2017

More information

CITY OF GLADSTONE APPLICATION FOR EMPLOYMENT (An Equal Opportunity Employer)

CITY OF GLADSTONE APPLICATION FOR EMPLOYMENT (An Equal Opportunity Employer) ~C t y i M o f i s G s l o a u d r s i t o n e ~ CITY OF GLADSTONE APPLICATION FOR EMPLOYMENT (An Equal Opportunity Employer) In keeping with our commitment to maintain a drug and alcohol-free workplace,

More information

CHRISTIAN COUNTY SHERIFF S OFFICE CORRECTIONAL CENTER * CENTER 301 W. FRANKLIN STREET P. O. BOX 678 TAYLORVILLE, IL 62568

CHRISTIAN COUNTY SHERIFF S OFFICE CORRECTIONAL CENTER * CENTER 301 W. FRANKLIN STREET P. O. BOX 678 TAYLORVILLE, IL 62568 CHRISTIAN COUNTY SHERIFF S OFFICE CORRECTIONAL CENTER * 9-1-1 CENTER 301 W. FRANKLIN STREET P. O. BOX 678 TAYLORVILLE, IL 62568 SHERIFF BRUCE KETTELKAMP PHONE (217) 824-4961 CHIEF DEPUTY FAX (217) 824-4963

More information

Private Investigator and/or Security Guard Qualifying Agent Application

Private Investigator and/or Security Guard Qualifying Agent Application Vermont Secretary of State Office of Professional Regulation 89 Main Street, 3 rd Floor Montpelier VT 05620-3402 Kara Shangraw Licensing Board Specialist (802) 828-1134 kara.shangraw@sec.state.vt.us www.vtprofessionals.org

More information

APPLICATION FOR PLACEMENT

APPLICATION FOR PLACEMENT Colorado Sex Offender Management Board (SOMB) APPLICATION FOR PLACEMENT as a New POLYGRAPH EXAMINER for the Adult and Juvenile Provider List Colorado Department of Public Safety Division of Criminal Justice

More information

APPLICATION FOR ADMISSION

APPLICATION FOR ADMISSION APPLICATION FOR ADMISSION UPMC SCHOOLS OF NURSING APPLICATION FOR ADMISSION The following schools are part of the UPMC Schools of Nursing. Please list in order of preference which school of nursing you

More information

Grand Prairie Fire Department Applicant Identification Form

Grand Prairie Fire Department Applicant Identification Form Revised 07/15 Grand Prairie Fire Department Applicant Identification Form Place Picture Name: Last First Middle DOB: Weight: Height: Hair Color: Eye Color: Social Security No.: D.L. #: Complete the areas

More information

Employment Application NOTICE OF POLICY

Employment Application NOTICE OF POLICY Shayne E. Heap, Sheriff Elbert County Sheriff s Office 751 Ute Avenue, P.O. Box 486 Kiowa, Colorado 80117 Ph: 303-621-2027 Fax: 303-621-2055 www.elbertcountysheriff.com Employment Application NOTICE OF

More information

SACRED HEART PARISH LA GRANGE, TEXAS

SACRED HEART PARISH LA GRANGE, TEXAS SACRED HEART PARISH LA GRANGE, TEXAS DIOCESE OF AUSTIN ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------

More information

Servant Nurse Staffing, LLC Phone Personal Information

Servant Nurse Staffing, LLC Phone Personal Information Servant Nurse Staffing, LLC Phone 806-687-1916 Email: info@servantnursesaffing.com Personal Information Full Name: Address: Last First M.I. Street Address Apartment/Unit # City State ZIP Code Home Phone:

More information

GENERAL APPLICATION FOR EMPLOYMENT

GENERAL APPLICATION FOR EMPLOYMENT GENERAL APPLICATION FOR EMPLOYMENT Human Resources City of New Smyrna Beach 210 Sams Avenue New Smyrna Beach, Florida 32168 PLEASE PRINT OR TYPE Date of Application Position(s) Applied For The City of

More information

Attachment A: Code of Ethics for Volunteers with Vulnerable Populations

Attachment A: Code of Ethics for Volunteers with Vulnerable Populations Attachment A: Code of Ethics for Volunteers with Vulnerable Populations This Code of Ethics must be submitted along with the Application to Volunteer with Vulnerable Populations and Authorization for Release

More information

YMCA OF MIDDLE TENNESSEE AUTHORIZATION AND RELEASE FOR THE PROCUREMENT OF A CONSUMER AND/OR INVESTIGATIVE CONSUMER REPORT

YMCA OF MIDDLE TENNESSEE AUTHORIZATION AND RELEASE FOR THE PROCUREMENT OF A CONSUMER AND/OR INVESTIGATIVE CONSUMER REPORT YMCA OF MIDDLE TENNESSEE AUTHORIZATION AND RELEASE FOR THE PROCUREMENT OF A CONSUMER AND/OR INVESTIGATIVE CONSUMER REPORT *This information will be used for verification and identification purposes only

More information

BASIC REQUIREMENTS LAW ENFORCEMENT EXPLORER PROGRAM. Minimum 2.0 academic grade point average prior to and maintained after appointment.

BASIC REQUIREMENTS LAW ENFORCEMENT EXPLORER PROGRAM. Minimum 2.0 academic grade point average prior to and maintained after appointment. BASIC REQUIREMENTS LAW ENFORCEMENT EXPLORER PROGRAM AGE: EDUCATION: PHYSICAL FITNESS: UNITED STATES CITIZENSHIP: Explorer / Cadet - Minimum Age 14 (Completed 8 th grade), or 15 years of age and not yet

More information

Thank you for your interest in volunteering with the Seton Angel Auxiliary.

Thank you for your interest in volunteering with the Seton Angel Auxiliary. VOLUNTEER APPLICATION Name: Thank you for your interest in volunteering with the Seton Angel Auxiliary. Love All - Serve All Today s Date: Mailing Address:: City/State/Zip Code Group/ Business you are

More information

CERTIFIED CLINICAL SUPERVISOR CREDENTIAL

CERTIFIED CLINICAL SUPERVISOR CREDENTIAL REQUIREMENTS: CERTIFIED CLINICAL SUPERVISOR CREDENTIAL Applicants must live or work at least 51% of the time within the jurisdiction of ADACBGA, or live or work in a jurisdiction that does not offer the

More information

TRAVIS COUNTY EMERGENCY SERVICES DISTRICT #4 FIRE AND EMT ACADEMY CADET CLASS XV APPLICATION

TRAVIS COUNTY EMERGENCY SERVICES DISTRICT #4 FIRE AND EMT ACADEMY CADET CLASS XV APPLICATION TRAVIS COUNTY EMERGENCY SERVICES DISTRICT #4 FIRE AND EMT ACADEMY CADET CLASS XV APPLICATION 11800 North Lamar #4B Austin, Texas 78753 (512) 836-7566 Office Hours 8:00am - 4:00pm READ ALL OF THE MINIMUM

More information

Dear Volunteen Applicant:

Dear Volunteen Applicant: Dear Volunteen Applicant: Thank you for your interest in volunteering at Marian Regional Medical Center. Our Volunteen Program is for current high school students who are at least 14 years old. Please

More information

Thank You for your interest in joining our TEAM!

Thank You for your interest in joining our TEAM! Thank You for your interest in joining our TEAM! UNITED DOCTORS FAMILY MEDICAL CENTER is dedicated to the highest quality of care for its patients. This mission requires a dynamic organization which embodies

More information

Thank you for your interest in Tropic Ocean Airways.

Thank you for your interest in Tropic Ocean Airways. Thank you for your interest in Tropic Ocean Airways. Please complete the attached application, scan and return to us as soon as possible. If you are a Military Veteran (thank you for your service), please

More information

Susan Busler & Judi Peters Polk County 4-H Youth Development

Susan Busler & Judi Peters Polk County 4-H Youth Development E XTENSION SERVICE P OLK COUNTY March 24, 2017 To: Prospective 4-H Volunteers Re: New Volunteer Orientation Welcome to the wonderful world of 4-H! We re so pleased that you are joining - or are thinking

More information

DIVISION OF LICENSING PROGRAMS VIRGINIA DEPARTMENT OF SOCIAL SERVICES RENEWAL APPLICATION FOR A STATE LICENSE TO OPERATE AN ASSISTED LIVING FACILITY

DIVISION OF LICENSING PROGRAMS VIRGINIA DEPARTMENT OF SOCIAL SERVICES RENEWAL APPLICATION FOR A STATE LICENSE TO OPERATE AN ASSISTED LIVING FACILITY DIVISION OF LICENSING PROGRAMS VIRGINIA DEPARTMENT OF SOCIAL SERVICES Page 1 of 6 RENEWAL APPLICATION FOR A STATE LICENSE TO OPERATE AN ASSISTED LIVING FACILITY This application shall be signed by the

More information

Please print clearly as you fill out the application. Social Security #: Are you known by other names while previously employed?

Please print clearly as you fill out the application. Social Security #: Are you known by other names while previously employed? San Xavier District Tohono O'odham Nation Please print clearly as you fill out the application. Human Resources Office Only Date Received: Title of Position Desired: How did you learn about this vacancy:

More information

SAISD Volunteer Information Packet

SAISD Volunteer Information Packet SAISD Volunteer Information Packet Thank you for choosing to volunteer in the San Antonio Independent School District. We hope that the time that you spend volunteering at SAISD is both fun and rewarding.

More information

LEAGUE CITY VOLUNTEER FIRE DEPARTMENT 555 W. Walker League City, TX Phone

LEAGUE CITY VOLUNTEER FIRE DEPARTMENT 555 W. Walker League City, TX Phone LEAGUE CITY VOLUNTEER FIRE DEPARTMENT 555 W. Walker League City, TX 77573 Phone 281-554-1465 Dear Applicant: Thank you for your interest in becoming a member of the League City Volunteer Fire Department.

More information

APPLICATION FOR VOLUNTEER cX (7-13)

APPLICATION FOR VOLUNTEER cX (7-13) JERSEY SHORE UNIVERSITY 1945 State Route 33 Neptune, NJ 07754 732-776-4177 OCEAN MEDICAL CENTER 425 Jack Martin Blvd. Brick, NJ 08724 732-840-3373 RIVERVIEW 1 Riverview Plaza Red Bank, NJ 07701 732-530-2253

More information

Application for Employment. Page 1 07/18

Application for Employment. Page 1 07/18 Application for Employment Page 1 Dear Applicant, Thank you for expressing interest in the Washington State University Cougar Security Program. The following outline should help you understand the program,

More information

West Orange Police Department Operation HOPE ANGEL Volunteer Application and Background Query Release Form

West Orange Police Department Operation HOPE ANGEL Volunteer Application and Background Query Release Form West Orange Police Department Operation HOPE ANGEL Volunteer Application and Background Query Release Form *All Applications can be filled out online at www.westorange.org or can be e-mailed directly to

More information

Certified or able to be certified as a Michigan Law Enforcement Officer Must have one of the following:

Certified or able to be certified as a Michigan Law Enforcement Officer Must have one of the following: FULL TIME POLICE OFFICER The City of Lincoln Park is accepting applications to create an eligibility list for Full Time Police Officer. The starting salary offered is $42,525.30. The deadline to apply

More information

Once accepted into the Program applicant will be required to pass a physical exam.

Once accepted into the Program applicant will be required to pass a physical exam. 5800 Uvalde Road Bldg. 17, Office 2114 Houston, Texas 77049 281-998-6150 Ext: 7132 vnnursingnorth@sjcd.edu Name: G00 Application for Vocational Nursing Program-North Campus: This application and this checklist

More information

COMMISSIONED SECURITY OFFICER APPLICATION

COMMISSIONED SECURITY OFFICER APPLICATION COMMISSIONED SECURITY OFFICER APPLICATION FOR OFFICE USE ONLY EFFECTIVE 12-2016 EXPIRES PROCESSED BY NOTICE: Information contained on this application is considered a public record and may be released

More information

HOISINGTON POLICE DEPARTMENT 109 E. 1 st St. Hoisington, KS Telephone (620) Fax (620)

HOISINGTON POLICE DEPARTMENT 109 E. 1 st St. Hoisington, KS Telephone (620) Fax (620) Chief of Police Kenton L. Doze HOISINGTON POLICE DEPARTMENT 109 E. 1 st St. Hoisington, KS 675440060 Telephone (620) 6534995 Fax (620) 6532422 Captain of Police Josh Nickerson Job : Police Officer Under

More information

We look forward to meeting and learning more about you! ~ St. Luke s Volunteer Leadership Team

We look forward to meeting and learning more about you! ~ St. Luke s Volunteer Leadership Team DEPARTMENT OF VOLUNTEER SERVICES Dear Prospective Volunteer: Thank you for your interest in our volunteer program! We believe you will find volunteering for St. Luke's University Health Network to be a

More information

Volunteer Receptionists

Volunteer Receptionists Duties: The South Bay Fire Department, Thurston County FPD 8, is currently accepting applications for Volunteer Receptionists Welcome and direct visitors to the District Answer multi-line phone promptly

More information

OSU Extension 4 H Volunteer Application Revised

OSU Extension 4 H Volunteer Application Revised OSU Extension 4 H Volunteer Application Revised 7.31.17 Adults or teens should complete and submit this 2 page application if they are interested in (a) teaching, coaching, advising or chaperoning youth

More information

AMERICAN AMBULANCE SERVICE, INC.

AMERICAN AMBULANCE SERVICE, INC. AMERICAN AMBULANCE SERVICE, INC. Proud to be a tobacco and smoke-free environment ONE AMERICAN WAY, NORWICH, CT 06360 VOLUNTEER APPLICATION GENERAL INFORMATION Date Name Last First MI Address Street City

More information

Town of Southampton Police Department

Town of Southampton Police Department Town of Southampton Police Department David G. Silvernail Police Chief Business 413-527-1120 Fax 413-527-8776 PO Box 239, 8 East Street, Southampton, Ma 01073 Police Officer Application Applications are

More information

MATTAPONI VOLUNTEER RESCUE SQUAD 6089 CANTERBURRY ROAD, WALKERTON, VA PHONE

MATTAPONI VOLUNTEER RESCUE SQUAD 6089 CANTERBURRY ROAD, WALKERTON, VA PHONE MATTAPONI VOLUNTEER RESCUE SQUAD 6089 CANTERBURRY ROAD, WALKERTON, VA 23177 PHONE 804-769-9455 E-MAIL MVRSINFO@GMAIL.COM MEMBER APPLICATION Dear Applicant: Mattaponi Volunteer Rescue Squad is an all-volunteer

More information

GEORGIA PEACE OFFICER STANDARDS AND TRAINING COUNCIL

GEORGIA PEACE OFFICER STANDARDS AND TRAINING COUNCIL GEORGIA PEACE OFFICER STANDARDS AND TRAINING COUNCIL APPLICATION FOR PRE-SERVICE TRAINING Return to: GEORGIA PEACE OFFICER STANDARDS AND TRAINING COUNCIL P.O. Box 349 Clarkdale, Georgia 30111 FOREWORD

More information

Application for Employment. An Equal Opportunity Employer

Application for Employment. An Equal Opportunity Employer Application for Employment (Please print clearly) An Equal Opportunity Employer Our practice does not discriminate on the basis of race, religion, natural origin, color, sex, age, veteran status, disability,

More information

APPLICATION FOR EMPLOYMENT FOR CDL DRIVERS

APPLICATION FOR EMPLOYMENT FOR CDL DRIVERS APPLICATION FOR EMPLOYMENT FOR CDL DRIVERS CAREFUL AND THOUGHTFUL COMPLETION OF THIS APPLICATION IS AN IMPORTANT STEP IN OUR CONSIDERATION OF INDIVIDUALS FOR EMPLOYMENT. PLEASE COMPLETE THE ENTIRE APPLICATION.

More information

Football & Cheerleading. Youth Sports Coaches Volunteer Application

Football & Cheerleading. Youth Sports Coaches Volunteer Application Football & Cheerleading Youth Sports Coaches Volunteer Application YOUTH SPORTS VOLUNTEER JOB DESCRIPTION TITLE: DESCRIPTION: Volunteer Coach for Gainesville Parks and Recreation Agency. *Coach of male

More information

Applicant Name: First Middle Last. Age: Birth Date: Applicant Cell Phone: Address Phone: Number & Street Name City Zip Code

Applicant Name: First Middle Last. Age: Birth Date: Applicant Cell Phone: Address Phone: Number & Street Name City Zip Code PLEASE PRINT : Applicant Name: First Middle Last Age: Birth : Applicant Cell Phone: Address Phone: Number & Street Name City Zip Code (Applicant s) E-mail address: / Applicant s Parent s Legal Guardian/Mother/Father

More information

Volunteer Application Package

Volunteer Application Package Volunteer Application Package April, 2016 This program is supported by the Georgia Department of Human Services/Division of Aging Services/GeorgiaCares Program with financial assistance, in whole or in

More information

State of Florida Department of Health. Board of Osteopathic Medicine. Application for Registration as an Osteopathic Physician in Training

State of Florida Department of Health. Board of Osteopathic Medicine. Application for Registration as an Osteopathic Physician in Training State of Florida Department of Health Board of Osteopathic Medicine Application for Registration as an Osteopathic Physician in Training Board of Osteopathic Medicine 4052 Bald Cypress Way, #C-06 Tallahassee,

More information

State of Iowa Standard Teacher Employment Application

State of Iowa Standard Teacher Employment Application State of Iowa Standard Teacher Employment Application Application Date: Date Available: Name: Social Security #: U.S. Citizen: Are you legally eligible to work in the United States? Current Home Phone:

More information

MERCER COUNTY SHERIFF S OFFICE CITIZEN S ACADEMY APPLICATION

MERCER COUNTY SHERIFF S OFFICE CITIZEN S ACADEMY APPLICATION MERCER COUNTY SHERIFF S OFFICE CITIZEN S ACADEMY APPLICATION Mercer County Sheriff's Office 4835 State Route 29 Celina, OH 45822 8216 Telephone: 419-586-7724 Fax: 419-586-2234 JEFF GREY SHERIFF JODIE LANGE

More information

Present Address Telephone ( ) Street City State Zip. Permanent Address Telephone ( ) Social Security Number / / address

Present Address Telephone ( ) Street City State Zip. Permanent Address Telephone ( ) Social Security Number / /  address Application for Classified Personnel Minden Public Schools An Equal Opportunity/Affirmative Action Employer 543 West Third Phone: (308) 832-2440 Minden, NE 68959 Fax: (308) 832-2567 Please type or print

More information

YATES COUNTY PERSONNEL DEPARTMENT

YATES COUNTY PERSONNEL DEPARTMENT Yates County is an Equal Opportunity Employer. Yates County does not unlawfully discriminate in employment because of age, race, creed, color, national origin, sex, sexual orientation, disability, marital

More information