Peoria PlayHouse Children s Museum Volunteer Application

Size: px
Start display at page:

Download "Peoria PlayHouse Children s Museum Volunteer Application"

Transcription

1 Peoria PlayHouse Children s Museum Volunteer Application Thank you for your interest in volunteering at the PlayHouse Children s Museum! Volunteers play a vital role in the success of our museum and we rely on dynamic and dedicated volunteers, just like you, every day. Please do be sure you have completed the application fully before submission and, if you have a resume available, please include that with your application form. General Information: We can t wait to meet you! Name Last First Middle Address Street City State Zip Phone (specify home/cell) Preferred contact method: Phone Your Organization/Group (if applicable) Emergency Contact: Name Phone Relationship Do you have any condition or disability for which you may require accommodation to perform the essential functions of a task or activity? Employer/School Title/Occupation If a student, are Highest level of education completed Please provide two personal references: Name Phone/ Street Address City, State Zip Are you seeking volunteer hours to fulfill court ordered community service? Y N

2 Personal Information and Experience: The Peoria PlayHouse Children s Museum offers many different volunteer opportunities and volunteer roles will continue to evolve over time. To better help us place you within available opportunities, please rank the following areas below by interest, if you have direct experience in each field, and/or any applicable skills. I m interested I m experienced (If so, please explain) Please list applicable skills Working with families Y N Working with children 0-3 Y N Working with children 4-8 Y N Working with children 9-12 Y N Science and engineering Y N Nature (horticulture, animals, ecosystems, etc.) Y N Language Arts and Literacy Y N Farming Y N Office support and mailings Y N Guest services Y N Do you possess any other skills or expertise that would be of benefit to the PlayHouse Museum? Do you speak any languages, other than English? Why do you want to volunteer for the Peoria PlayHouse Children s Museum?

3 What would make you a good PlayHouse Museum Volunteer? Availability: We ask that all volunteers give a minimum of 8 hours (two 4-hour shifts) per month. Once trained, we also ask that volunteers commit to at least one year of service. Check all that apply below: Monday Tuesday Wednesday Thursday Friday Saturday Sunday Morning Afternoon Evening Please complete the following: Have you ever been convicted of a misdemeanor (crime involving dishonesty or violence) or a felony crime? Yes No If yes, describe: (Conviction will not necessarily be a bar to volunteering. Every instance and explanation will be considered individually.) All regular volunteer assignments are contingent upon the successful completion of screening requirements, for example: background checks, driver abstract check and a drug screen. Driver s License or State ID Number Date of Birth Your signature authorizes the investigation of all information pertaining to the screening items as may be necessary. Signature of volunteer or parent/guardian Date

4 Peoria Park District Volunteer Liability Waiver Volunteer's Name (Please Print) Facility/Event/Project Assignment Title (If known) (If known) As a volunteer for the Peoria Park District or the parent/guardian of a volunteer, I recognize and acknowledge that there are certain risks of physical injury and I agree to assume full responsibility of any injuries, including death, damages or loss which I or my minor child/ward may sustain as a result of participating in the volunteer program. I do hereby fully release and discharge the Peoria Park District and its officers, agents, servants, and employees from any and all claims from injuries, including death, damage or loss which I or my minor child/ward may have or which may accrue to me on account of participation in the volunteer program. In the event of an emergency, I authorize Peoria Park District officials to secure from any licensed hospital, physician, and/or medical personnel or good samaritan first aid providers, any treatment deemed necessary for my immediate care and agree that I will be responsible for payment of any and all medical services rendered. I understand that the Peoria Park District provides secondary medical expense coverage up to $5,000 for injuries incurred while performing my volunteer duties. I also understand that my personal health coverage or medic are/medic aid coverage must pay first. In addition, I hereby consent to the use of my photograph in Park District brochures, publications, slide presentations, etc. I have read and fully understand the above details of the volunteer program waiver and release of all claims and permission to secure medical treatment. Signature of Volunteer or Parent/Guardian A parent/guardian must sign for a minor. Date Thank you for applying. Please return the signed, dated Application (4 pages) to: Volunteer Coordinator PEORIA PARK DISTRICT 1125 W. Lake Avenue Peoria, IL FAX (309) PH (309) or 2822 Revised 2/25/2015 For office use only: Date office received: Background check received: Volunteer accepted / denied Notified: Volunteer Position and Location: Project supervisor and phone:

5 5

APPLICATION FOR EMPLOYMENT

APPLICATION FOR EMPLOYMENT APPLICATION FOR EMPLOYMENT Applicants for a home care aide position must have a current DC home health aide certification or had at least 125 hours of Home Care Aide training. Applicants for a CNA position

More information

Have a car No pets Years of Experience

Have a car No pets Years of Experience 92 Thompson Road Avon, CT 06001 : (860) 357-5333 Fax: (860) 629-0858 Check all that apply: ID Card Driver s License US Passport Want Live-out CNA (State ) HHA Want Live-in Want Live-out Have a car No pets

More information

CARSON CITY VOLUNTEER/INTERN APPLICATION. Volunteer/Intern Name: City, State, Zip: Day Phone: Night Phone: Cell Phone:

CARSON CITY VOLUNTEER/INTERN APPLICATION. Volunteer/Intern Name: City, State, Zip: Day Phone: Night Phone: Cell Phone: CARSON CITY VOLUNTEER/INTERN APPLICATION Date: Volunteer/Intern Name: Home Address: City, State, Zip: Day Phone: Night Phone: Cell Phone: E-mail: Occupation: Business Name: Phone: Are you under the age

More information

Freya's Cat Rescue. a 501(c)(3) non-profit organization P. O. Box 264 Tennent, New Jersey Application for Volunteers and Interns

Freya's Cat Rescue. a 501(c)(3) non-profit organization P. O. Box 264 Tennent, New Jersey Application for Volunteers and Interns 1 TM a 501(c)(3) non-profit organization P. O. Box 264 Tennent, New Jersey 07763 Application for Volunteers and Interns Today s Date: Personal Information Name: Address: City: State: Zip: Home Phone: Work

More information

TEEN VOLUNTEER APPLICATION (AGES 16-17)

TEEN VOLUNTEER APPLICATION (AGES 16-17) TEEN VOLUNTEER APPLICATION (AGES 16-17) APPLICATION MUST BE FILLED OUT BY THE INDIVIDIAL APPLYING FOR THE VOLUNTEER POSITION. Completed applications can be returned to Lake Wales Medical Center Dir. Volunteer

More information

How to become a Mercy General Hospital Volunteer

How to become a Mercy General Hospital Volunteer How to become a Mercy General Hospital Volunteer Thank you for your interest in the Mercy General Hospital Volunteer Program. The information below explains the process for becoming a volunteer. The process

More information

EMPLOYMENT APPLICATION

EMPLOYMENT APPLICATION Date: EMPLOYMENT APPLICATION Last Name: First Name: MI: Social Security Number: Home Phone: Driver s license #: Cell Phone: Email: Street Address: City: State: Zip: How long have you resided at your current

More information

Please complete this application by pen (print) or typewriter in its entirety. PERSONAL INFORMATION. First MI Last. Street City State Zip

Please complete this application by pen (print) or typewriter in its entirety. PERSONAL INFORMATION. First MI Last. Street City State Zip Qualified applicants are considered for all positions without regard to race, color, religion, gender, national origin, age, covered veteran's status, marital status, or the presence of a non-job-related

More information

Lighthouse Youth & Family Services Volunteer & Intern Application

Lighthouse Youth & Family Services Volunteer & Intern Application Lighthouse Youth & Family Services Volunteer & Intern Application Volunteers are a vital part of Lighthouse, and there s a lot you can do. Give back by investing your time and talent in helping children,

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

Volunteer Acknowledgement and Agreement

Volunteer Acknowledgement and Agreement Volunteer Acknowledgement and Agreement West Palm Beach, Florida 33407-3277 As a volunteer of, I will benefit working with other committed individuals, who are assisting people with disabilities and other

More information

Sitters At Your Service, LLC

Sitters At Your Service, LLC Sitters At Your Service, LLC EMPLOYMENT APPLICATION Please mail to: P.O. Box 43021 Richmond Heights, OH 44143 216-323-7800 info@sittersays.com Sitters At Your Service, LLC is an equal opportunity/affirmative

More information

BEN CLARK TRAINING CENTER RIVERSIDE COUNTY SHERIFF S DEPARTMENT DAVIS AVENUE SUITE A, RIVERSIDE, CA

BEN CLARK TRAINING CENTER RIVERSIDE COUNTY SHERIFF S DEPARTMENT DAVIS AVENUE SUITE A, RIVERSIDE, CA COURSE TITLE: CITIZENS ACADEMY OVERVIEW: Attendees will learn the daily operations of the Sheriff s Department, along with policies and procedures within law enforcement. Various topics will include the

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

Volunteer Services. VOLUNTEER POSITIONS AVAILABLE Day Camps Recreation & Special Events Therapeutic After School Programs Special Olympics

Volunteer Services. VOLUNTEER POSITIONS AVAILABLE Day Camps Recreation & Special Events Therapeutic After School Programs Special Olympics Volunteer Services Thank you for your interest in the Volunteer Program at Longview Parks & Recreation. We are committed to creating community through people, parks & programs. We are seeking volunteers

More information

Colorado Therapeutic Riding Center Mineral Road, Longmont, CO (303) FAX (303)

Colorado Therapeutic Riding Center Mineral Road, Longmont, CO (303) FAX (303) Colorado Therapeutic Riding Center 11968 Mineral Road, Longmont, CO 80504 (303) 652-9131 FAX (303) 652-2072 Dear Prospective Intern: Thank you for your interest in interning at the Colorado Therapeutic

More information

COUNTY OF SACRAMENTO Probation Department

COUNTY OF SACRAMENTO Probation Department COUNTY OF SACRAMENTO Probation Department 9750 BUSINESS PARK DRIVE, SUITE 220, SACRAMENTO, CALIFORNIA 95827 TELEPHONE (916) 875-0273 FAX (916) 875-0347 LEE SEALE CHIEF PROBATION OFFICER COUNTY PAROLE OFFICER

More information

- - ORIENTATION DATE:

- - ORIENTATION DATE: Dane County Humane Society Volunteer Application Dane County Humane Society is currently recruiting adults and children age 8 and older to participate in our volunteer program and support our mission Helping

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

Michael Jordan. Questions? Please contact: Director of Youth Ministry. Phone: x230

Michael Jordan. Questions? Please contact: Director of Youth Ministry. Phone: x230 What: Youth will travel to Idaho to partner with Idaho Servant Adventures, a ministry of Lutherhaven. During this servant-leadership camp, we will work alongside other youth groups repairing and transforming

More information

Application for Employment

Application for Employment Application for Employment San Benito Health Foundation Community Health Center (An Equal Opportunity Employer) Please review the entire application before you begin. Legibility, accuracy, organization

More information

Volunteer Response Advocate/Intern Application Form

Volunteer Response Advocate/Intern Application Form Volunteer Response Advocate/Intern Application Form Instructions: Please complete this form as completely as you can to help us to understand your interests and qualifications as a prospective employee.

More information

VOLUNTEER APPLICATION FORM

VOLUNTEER APPLICATION FORM VOLUNTEER APPLICATION FORM FOR OFFICE USE Date received Action All information on this, whether submitted online or in paper directly to Deer Lodge Centre will be entered to a website owned by Volgisitics,

More information

Dear Volunteer: Sincerely, Medicare Grants Staff

Dear Volunteer: Sincerely, Medicare Grants Staff Dear Volunteer: Thank you for your interest in the Kansas Medicare Grants volunteer program. The contents of this application packet are designed to help answer common questions about the Medicare Grants

More information

ADMISSION INFORMATION

ADMISSION INFORMATION Texas Dept of Family and Protective Services ADMISSION INFORMATION Form 2935 Aug 2010 / Pg 1 of 3 Operation Name The Stepping Stone Director s Name Ashley Stock Child s Full Name Child s of Birth Child

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

The Family Crisis Center of East Texas, Inc. (Women s Shelter of East Texas)

The Family Crisis Center of East Texas, Inc. (Women s Shelter of East Texas) The Family Crisis Center of East Texas, Inc. (Women s Shelter of East Texas) Volunteer/ Advocate Application (Including Interns and Work Study) Please check one: (See Volunteer Categories for details)

More information

Volunteer/Staff Information Form and Health History General Information

Volunteer/Staff Information Form and Health History General Information Volunteer/Staff Information Form and Health History General Information Name: Date of Birth: Date: Local Address: Street: City: Summer Address: Street: State: Zip: State: Zip: Phone: City: Local Phone:

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

Cherokee County Fire & Emergency Services

Cherokee County Fire & Emergency Services Cherokee County Fire & Emergency Services Application for the Position of: VOLUNTEER SERVICE REV.9/2010 CHEROKEE COUNTY FIRE & EMERGENCY SERVICES 150 Chattin Drive, Canton, GA 30115 678-493-4000 (phone)

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

WESTMINSTER POLICE DEPARTMENT

WESTMINSTER POLICE DEPARTMENT WESTMINSTER POLICE DEPARTMENT CITIZENS ACADEMY WESTMINSTER CITIZENS POLICE ACADEMY The Westminster Police Department will be hosting the Citizens Police Academy beginning January 24 th, 2018. The class

More information

Date Position Applying For Department PERSONAL INFORMATION. Social Security Number Last First Middle Present Address Street City State Zip

Date Position Applying For Department PERSONAL INFORMATION. Social Security Number Last First Middle Present Address Street City State Zip Tucson Indian Center 97 East Congress Street, Suite 101 * P.O. Box 2307 * Tucson, Arizona 85702-2307 Telephone: (520) 884-7131 * Fax: (520) 884-0240 Application for Employment Date Position Applying For

More information

An Equal Opportunity Employer. RECRUITMENT RANGE $0.00 /Hour

An Equal Opportunity Employer. RECRUITMENT RANGE $0.00 /Hour ISSUE DATE: 11/27/17 THE POSITION ESCAMBIA COUNTY Department of Human Resources 221 Palafox Place, HR Suite 200 Pensacola, FL 32502-5835 (850) 595-3000 Out-of-Area: (866) 609-0603 http://www.myescambia.com/jobs

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

Zoo Education Internships

Zoo Education Internships Zoo Education Internships Are you ready to develop the skills needed for a successful career? Summer 2015 Internship Dates: May 18-August 15 Columbian Park Zoo is looking for energetic students to assist

More information

VOLUNTEER APPLICATION

VOLUNTEER APPLICATION VOLUNTEER APPLICATION Dear Applicant: Thank you for your interest in the Volunteer Program at the Kaiser Permanente Antelope Valley Medical Offices. We welcome interested and enthusiastic people of all

More information

Release of Information, Medical and Liability Waiver. Packet

Release of Information, Medical and Liability Waiver. Packet Release of Information, Medical and Liability Waiver Packet The following information must be completed, signed and RETURNED by April 2nd, 2018 no later than 5pm. 1 Application Remittance Information and

More information

VOLUNTEER WITH US. 332 Stable Lane Wentzville MO Phone (636) Fax (636)

VOLUNTEER WITH US. 332 Stable Lane Wentzville MO Phone (636) Fax (636) VOLUNTEER WITH US 332 Stable Lane Wentzville MO 63385 Phone (636) 332-4940 Fax (636) 332-4941 WWW.THSTL.ORG Dear Prospective Volunteer, TREE House of Greater St. Louis (TH) is one of the nation s oldest

More information

SC Uniform Managed Care Provider Credentialing Application

SC Uniform Managed Care Provider Credentialing Application SC Uniform Managed Care Provider Credentialing Application I. PERSONAL INFORMATION Solo Practice Group Practice Name: Last First M.I. Suffix Degree Maiden and/or other name List W-9 name if different Place

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

FAMILY CHRISTIAN CENTER SCHOOL BEFORE and AFTERCARE APPLICATION

FAMILY CHRISTIAN CENTER SCHOOL BEFORE and AFTERCARE APPLICATION : FAMILY CHRISTIAN CENTER SCHOOL BEFORE and AFTERCARE APPLICATION Student Please Print Name Grade: Age: Review the following to ensure completion of the application process. Registration fee (due upon

More information

VOLUNTEER & PROFESSIONAL SERVICES APPLICATION TRAVIS COUNTY SHERIFF S OFFICE Travis County Jail & Travis County Correctional Complex INSTRUCTION SHEET

VOLUNTEER & PROFESSIONAL SERVICES APPLICATION TRAVIS COUNTY SHERIFF S OFFICE Travis County Jail & Travis County Correctional Complex INSTRUCTION SHEET VOLUNTEER & PROFESSIONAL SERVICES APPLICATION TRAVIS COUNTY SHERIFF S OFFICE Travis County Jail & Travis County Correctional Complex INSTRUCTION SHEET Thank you for your interest in being a volunteer or

More information

Big Brothers Big Sisters

Big Brothers Big Sisters General Volunteer Application Application Date Volunteer Position Sought Name Home Address Work Phone Home Phone EDUCATION Highest Level of Education EMPLOYMENT Current Employer, if applicable: Position/Title

More information

Citizens Academy Curriculum

Citizens Academy Curriculum About the Citizens Academy... Citizens Academy Curriculum Classes subject to change. The Citizens Academy is a fifteen (15) week program designed to give participants an inside look at local law enforcement.

More information

Dear Prospective Volunteer,

Dear Prospective Volunteer, Dear Prospective Volunteer, Vaughan Animal Services would like to take this opportunity to thank you for your interest in our volunteer program. Please note we currently have three volunteer programs to

More information

PROSPECT PARK ZOO Project TRUE Urban Ecology Program Application School Year (Please Print)

PROSPECT PARK ZOO Project TRUE Urban Ecology Program Application School Year (Please Print) PROSPECT PARK ZOO Project TRUE Urban Ecology Program Application School Year 2014 2015 (Please Print) Name Date Address City/State/Zip Home phone: Cell phone: Work phone: Email: Date of Birth: EDUCATION:

More information

Springfield Police Department CITIZEN RIDE-ALONG PROGRAM

Springfield Police Department CITIZEN RIDE-ALONG PROGRAM Springfield Police Department CITIZEN RIDE-ALONG PROGRAM Ever been curious what it s like to be a police officer? Here s your chance! The Springfield Police Department s ride-along program gives eligible

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

Rotary Youth Volunteer Application - (YE - Rotarian Volunteers)

Rotary Youth Volunteer Application - (YE - Rotarian Volunteers) Rotary District Youth Exchange Program Districts 7120, 7150, 7170, 7210 Student Protection Program Rotarian Volunteer Application/Background Check (Rev 7/10) Rotary International has directed that all

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

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

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

Dear Zoo Crew Applicant,

Dear Zoo Crew Applicant, Dear Zoo Crew Applicant, Thank you for your interest in Zoo Crew, the Children s Zoo teen volunteer program! For a complete list of program benefits visit our website at www.saginawzoo.com. Please read

More information

10689 N. 99 th Ave., Peoria, AZ Phone: (623) Fax: (623) Application for Employment. Employment Desired

10689 N. 99 th Ave., Peoria, AZ Phone: (623) Fax: (623) Application for Employment. Employment Desired 10689 N. 99 th Ave., Peoria, AZ 85345 Phone: (623) 977-3977 Fax: (623) 977-5067 Application for Employment Personal Information *Please do not leave any spaces blank. Write N/A if not applicable* : Name:

More information

Carlisle Police Department Employment Application

Carlisle Police Department Employment Application Employment Application ADMINISTRATIVE ASSISTANT APPLICATION Carlisle Police Department 195 N. First Street Carlisle, IA 50047 (515)-989-4121 WAIVER I, agree to submit to written, physical agility, physical,

More information

North Carolina Extension Master Gardener Volunteer Application Guilford County

North Carolina Extension Master Gardener Volunteer Application Guilford County North Carolina Extension Master Gardener Volunteer Application Guilford County Please return all seven (7) pages of the completed Application to: 3309 Burlington Rd, Greensboro, NC 27405 GENERAL INFORMATION

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

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

Volunteer Application (Please print)

Volunteer Application (Please print) *= REQUIRED INFORMATION Volunteer Application (Please print) Date: *Name: Birth date: *Address: *City/State/Zip: Home Phone: Work Phone: (Only provide # if able to contact you at work) Cell Phone: Email:

More information

Hamburg Township. Per Diem Recording Secretary

Hamburg Township. Per Diem Recording Secretary FAX 810-231-4295 PHONE 810-231-1000 www.hamburg.mi.us P.O. Box 157 10405 Merrill Road Hamburg, Michigan 48139 Hamburg Township Per Diem Recording Secretary Hamburg Township is seeking a Recording Secretary

More information

Adult Volunteer Application

Adult Volunteer Application Adult Volunteer Application Dear Community Friend: Thank you for your interest in volunteering at Slidell Memorial Hospital (SMH). Volunteering can be quite rewarding and, of course, is a great help to

More information

CITY OF ROSEVILLE, CALIFORNIA ADMINISTRATIVE REGULATION

CITY OF ROSEVILLE, CALIFORNIA ADMINISTRATIVE REGULATION CITY OF ROSEVILLE, CALIFORNIA ADMINISTRATIVE REGULATION APPROVED: Number: A.R. 2.12 Date Effective: April 7, 1999 W. Craig Robinson, City Manager Date Revised: October 4, 2007 SUBJECT: VOLUNTEERS/NON-CITY

More information

Carlisle Police Department Employment Application

Carlisle Police Department Employment Application Employment Application POLICE OFFICER APPLICATION Carlisle Police Department 195 N. First Street Carlisle, IA 50047 (515)-989-4121 CARLISLE POLICE DEPARTMENT Instruction for Applicants **Please do Not

More information

Controlled Unless Printed. Dear Prospective Volunteer,

Controlled Unless Printed. Dear Prospective Volunteer, Dear Prospective Volunteer, Thank you for your interest in Asante Ashland Community Hospital s Volunteer Program. We value our volunteers and could not provide the quality of care to our patients and visitors

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

TEXAS. Technology Students Association FORMS

TEXAS. Technology Students Association FORMS TEXAS Technology Students Association FORMS 2017-2018 1: Texas TSA Protest Form. Please note that protest for NQE Entries MUST use the National TSA Protest Form Form found below and in the National TSA

More information

APPLICATION FOR EMPLOYMENT Wallace Community College Selma

APPLICATION FOR EMPLOYMENT Wallace Community College Selma Additional infromation Secondary and Postsecondary Education Personal Information Position Information Alabama Community System Application No. APPLICATION FOR EMPLOYMENT Wallace Community Selma Title

More information

REEDSBURG AREA AMBULANCE SERVICE EMPLOYMENT APPLICATION

REEDSBURG AREA AMBULANCE SERVICE EMPLOYMENT APPLICATION REEDSBURG AREA AMBULANCE SERVICE EMPLOYMENT APPLICATION NOTICE: Application must be typewritten or clearly printed in ink. All questions must be answered, if applicable. If not, indicate NA (not applicable).

More information

City of Tomah Tomah Area Ambulance Service Employment Application

City of Tomah Tomah Area Ambulance Service Employment Application City of Tomah Tomah Area Ambulance Service Employment Application EMT Advanced EMT Paramedic Check Licensure Level Please complete this application if you wish to apply for employment with the City of

More information

Wyoming County Employment Application

Wyoming County Employment Application Wyoming County Employment Application We consider applicants for all positions without regard to race, color, religion, creed, gender, national origin, age, disability, marital, veteran, or any other legally

More information

Minneapolis Golf Club APPLICATION FOR MEMBERSHIP

Minneapolis Golf Club APPLICATION FOR MEMBERSHIP Minneapolis Golf Club APPLICATION FOR MEMBERSHIP Golf Membership Date of Application I hereby apply for membership in the Minneapolis Golf Club, St. Louis Park, Minnesota. I agree to pay such annual dues,

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

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

Deadline for application: April 1-29, Dear Summer Teen Applicant:

Deadline for application: April 1-29, Dear Summer Teen Applicant: Deadline for application: April 1-29, 2016 Dear Summer Teen Applicant: Thank you for your interest in the Summer VolunTeen Program at Methodist Healthcare. Positions are available at Methodist University,

More information

APPLICATION FOR EMPLOYMENT

APPLICATION FOR EMPLOYMENT Alabama Community College System Application No. APPLICATION FOR EMPLOYMENT Northeast Alabama Community College Position Information Title of position for which you are applying: Date of Application Last

More information

SIDNEY FIRE DEPARTMENT Serving Our Community Since 1914 APPLICATION FOR VOLUNTEER FIREFIGHTER

SIDNEY FIRE DEPARTMENT Serving Our Community Since 1914 APPLICATION FOR VOLUNTEER FIREFIGHTER SECTION A: NAME AND CONTACT INFORMATION 1. FIRST NAME 2. LAST NAME 3. HOME ADDRESS (Number, Street, City, Province, and Postal Code) 4. HOME PHONE: ( ) 5. CELL PHONE: ( ) 6. EMAIL ADDRESS: 7. PLEASE TELL

More information

In order to qualify as a Member of the Flagler Hospital Auxiliary, volunteers shall:

In order to qualify as a Member of the Flagler Hospital Auxiliary, volunteers shall: FLAGLER HOSPITAL INC. 400 Health Park Blvd. St. Augustine, FL 32086 904-419-4411 Dear Future Volunteer: Thank you for your interest in serving as a volunteer with the Flagler Hospital Auxiliary. We offer

More information

APPLICATION FORM FOR REGULAR VOLUNTEERS

APPLICATION FORM FOR REGULAR VOLUNTEERS Thank you for choosing to volunteer at KK Women s and Children s Hospital! Kindly provide us with your details below and we will be in contact with you soon. Please note: Please fill in ALL sections. The

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

BRIDGES 21 st Century Community Learning Center

BRIDGES 21 st Century Community Learning Center 78 Betsy Ross Lane Sylacauga, AL 35150 (256)245-4343 BRIDGES 21 st Century Community Learning Center Application Packet BRIDGES Registration Date: Free Lunch?: Yes No OR Reduced Lunch?: Yes No Have you

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

Application for Contracted Services

Application for Contracted Services PERSONAL INFORMATION Application for Contracted Services Last Name First Name Middle Name Address Apt# City State Zip Home Phone Cell Phone Email_Address Social Security Number Date / / What type of work

More information

Thank you for your interest in the Yorba Linda Public Library Children's Services Summer Volunteer Program!

Thank you for your interest in the Yorba Linda Public Library Children's Services Summer Volunteer Program! Thank you for your interest in the Yorba Linda Public Library Children's Services Summer Volunteer Program! The Children's Services summer volunteer program provides positive and fun community service

More information

Discovery Guide Program

Discovery Guide Program CENTRAL PARK ZOO EDUCATION DEPARTMENT Discovery Guide Program To The Applicant: Becoming a Discovery Guide at Central Park Zoo can be an exciting and rewarding volunteer experience. As a Discovery Guide,

More information

Please complete the following forms, which are mandatory, to become an IU Health volunteer. Your packet includes the following:

Please complete the following forms, which are mandatory, to become an IU Health volunteer. Your packet includes the following: Volunteer Services Dear Applicant: Thank you for your interest in the Indiana University Health Volunteer program for Methodist Hospital, Riley Hospital for Children, University Hospital and IU Simon Cancer

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

U.S. Army Aeromedical Research Laboratory Gains in the Education of Mathematics and Science Program PARTICIPANT APPLICATION

U.S. Army Aeromedical Research Laboratory Gains in the Education of Mathematics and Science Program PARTICIPANT APPLICATION To be considered for acceptance into the 2013 GEMS program, submit the following: 1. The Participant Application 2. The Participant Essay 3. The Participant Release Form 4. Participant Safety Information

More information

VOLUNTEER APPLICATION SATELLITE BEACH POLICE DEPARTMENT

VOLUNTEER APPLICATION SATELLITE BEACH POLICE DEPARTMENT Updated: 6/29/17 VOLUNTEER APPLICATION SATELLITE BEACH POLICE DEPARTMENT Return Completed Application to: 510 Cinnamon Drive, Satellite Beach, FL 32937 Personal Information Last Name: First Name: MI: Home

More information

RIDGE-CULVER FIRE DEPARTMENT

RIDGE-CULVER FIRE DEPARTMENT 11/25/2017 pg. 1 RIDGE-CULVER FIRE DEPARTMENT Rochester, New York 14622 Phone: (585) 467-4241 Thank you for your interest in becoming a member of the Ridge Culver Fire Department. The Ridge Culver Fire

More information

Volunteer Application and Placement Process

Volunteer Application and Placement Process Volunteer Application and Placement Process Thank you for your interest in volunteering at University of Colorado Hospital. Volunteers play an important and meaningful role in providing amazing service

More information

Instructions and Resource Page for Application for a License to Operate a Child Care Facility

Instructions and Resource Page for Application for a License to Operate a Child Care Facility Instructions and Resource Page for Application for a License to Operate a Child Care Facility Instructions: All information on this application must be truthful and correct. Complete this application in

More information

Washington State Historical Society. Update

Washington State Historical Society. Update Washington State Historical Society Volunteer Application Date of Hire Update Instructions: The Washington State Historical Society offers three locations for volunteer opportunities in Tacoma and Olympia.

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

Please return your completed application to

Please return your completed application to Dear Potential Volunteer, Thank you for your interest in volunteering with Charlotte Pediatric Clinic. Volunteers are an important part of our team and help us in many ways. We appreciate everyone who

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

AMERICA S BALLET SCHOOL

AMERICA S BALLET SCHOOL AMERICA S BALLET SCHOOL SUMMER INTENSIVE 2017 REQUIRED ADMISSION DOCUMENTS Below are the list of documents that must be submitted prior to attending ABS s Summer Intensive: EMERGENCY NOTIFICATION NOTICE

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

EDISON POLICE ACCEPTING APPLICATIONS FOR AUXILIARY POLICE OFFICERS

EDISON POLICE ACCEPTING APPLICATIONS FOR AUXILIARY POLICE OFFICERS EDISON DEPARTMENT OF PUBLIC SAFETY DIVISION OF POLICE THOMAS BRYAN, Chief of Police Thomas Lankey, MAYOR 100 Municipal Boulevard Edison, New Jersey 08817 Tele: (732) 248-7421 Fax: (732) 287-5719 Contact:

More information

Town of Madison Beach and Recreation Department After/Before School Program 8 Campus Drive Madison, CT Phone: (203) /Fax: (203)

Town of Madison Beach and Recreation Department After/Before School Program 8 Campus Drive Madison, CT Phone: (203) /Fax: (203) Per Connecticut General Statute 19a-77 we are required to disclose that our programs are not licensed by the State Office of Early Childhood. Dear Parent: To enroll your child(ren) in the, please complete

More information