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): Zip: Emergency Contact Name: Relationship: Telephone: Education (please circle level completed) Grade School: 7 8 9 10 11 12 College: 1 2 3 4 Technical School: Reason for Volunteering (check all that apply) Court Ordered Community Service School Requirement Personal Enrichment Other: Skills & Interests: Experience Volunteer Service: Work Experience: Days & Times Available: Volunteer Assignment Preferred (check all that apply) ESL Conversation Club Shelving Shelf-Reading Arts & Crafts (Children s Area) Reference Assistance Book mending Circulation Assistance Other:
I do understand and agree: APPLICATION FOR VOLUNTEER SERVICE Lone Star College-CyFair Branch Library That I must be at least 15 years old in order to volunteer at the Lone Star College-CyFair Branch Library That before starting a volunteer assignment, there can be a 7-10 day processing period. Call 281-290-3210 to check if and see if your application has been processed. I will regard my assignment as a serious commitment and abide by all library policies. That should my conduct or performance be deemed unsatisfactory for any reason I will be released from my assignment. That neither the Harris County Public Library System nor Lone Star College-CyFair and the Lone Star College System will be liable for injuries sustained by me, or any other person, as a result of my action, or the action of others. Applicant s Signature ------------------------------------------------------------------------------------------------------------ PERMISSION OF PARENT OR GUARDIAN FOR YOUTH VOLUNTEER I hereby voluntarily give my permission for (name) to volunteer at Harris County Public Library, Lone Star College-CyFair Branch. I understand that the library and the college are not to be held responsible in case of accident. Signature (Parent or Guardian)
CY-FAIR COLLEGE BRANCH LIBRARY VOLUNTEER RULES & PROCEDURE Welcome to the Lone Star College-CyFair Branch Library! To avoid misunderstandings, here are some of the main rules and procedures that you are expected to follow. Remember that your service here is important to us and that we rely on you. You are responsible for maintaining your own regular schedule. Accurately record your hours in the appropriate Volunteer Log. Breaks may be taken, but you will need to sign out and back in of the Volunteer Log. Do NOT work over 8 hours in a single shift. If you need a letter written showing that you have volunteered, please contact Diona West at 281-290-5277. Please give twenty-four hour notice that you need the letter. Be aware that your role at the library is a support role. If a patron asks you for assistance, refer them to the Reference desk. Respect confidentiality. In accordance with Texas state law, all library patrons records are confidential. Information about specific library usage must not be discussed. Be conscious of the fact that we are working in the public view. Dress neatly: no shorts, hats, gum chewing, etc. Keep talking to a minimum inside the library, especially in public areas. Limit telephone use to essential calls only. Do not use cell phones in library s public areas. Be considerate of housekeeping rules. Drinks may be taken into the workroom area only, not into the public area of the library. Food may be eaten in the kitchen only. Thank you for donating your time and expertise to the Lone Star College-CyFair Branch Library. We couldn t succeed without your help! I HAVE READ AND UNDERSTOOD THE RULES AND PROCEDURES FOR VOLUNTEERS AT THE LONE STAR COLLEGE-CYFAIR BRANCH LIBRARY. Signed
Criminal History (CHC) Authorization & Release Form (LSC-CyFair) To become employed with the Lone Star College System (LSCS) an individual must satisfactorily complete and pass a criminal history check (CHC). This form authorizes LSCS to obtain criminal history information on the prospective employee. Instructions: This form is to be completed by the applicant. Print legibly and complete all information requested. Deliver the completed form to the LSC-CyFair Human Resources Department, email to HR-CyFair@lonestar.edu or send via fax to Human Resources at 281-290-5298. Once the CHC results have been received, the department representative will be notified by Human Resources. This form must be submitted and results received prior to the first day of work. Last Name: First Name: Middle Name: of Birth: MM/DD/YYYY Place of Birth: City, State, County Male Phone Female Driver s License No. State Issued List Any Former Names Used: Current Address (Street, City, State & Zip Code): *State law authorizes institutions of higher education to obtain criminal history information on applicants for employment for security sensitive positions. List all locations where you have lived since age 18, beginning with your present place of residence. Use the back of the form if necessary. *Include the full address for any international locations** From To City State Zip Code County MM/YYYY MM/YYYY Acknowledgement and Authorization I hereby authorize Lone Star College System (LSCS) agent to furnish LSCS information related to my criminal history. I hereby release LSCS and all its officers, and employees, from all liability resulting from the use of information obtained as part of this background check. I certify that the information provided by me on this form is true, complete and correct to the best of my knowledge. I understand that any false information provided herein will void my application for employment and may result in termination. I further understand that a criminal history may disqualify me for employment at Lone Star College System. The Texas Privacy Act, with a few exceptions, allows you to be informed about the information Lone Star College System collects about you to review and obtain the information on this form and to correct any information you believe is incorrect. Signature Applicant/Employee: LSC Representative Completing Form Use Only: Position Security Change New Hire Full Time Part Time Position/Title Promotion Adjunct Student Worker Campus Representative Name Campus Representative Title Campus Location Campus Representative Contact # SHRM/Specialist Name Campus SHRM/Specialist Signature HRBackground@lonestar.ed u SO-HR Use Only: Record No Record : SO-HR Signature Satisfactory Unsatisfactory Campus President Contacted? Yes No :
Criminal History (CHC) Authorization & Release Form Page 2 Lone Star College System may obtain my background information, including criminal history record, Selective Service registration and degree verification at any time during my application process and/or employment. I understand this information will be used only for evaluation for employment or continued employment with Lone Star College System. The following are my responses to questions about my criminal history, if any. (Excluding minor traffic offenses punishable only by fine.) 1. Have you ever been convicted or plead guilty before a court for any federal, state or municipal criminal offense Details of Conviction: 2. Have you ever received deferred adjudication or similar disposition for any federal, state or municipal offense? _Yes No If Yes, please provide further details below. Attach extra pages if needed. 3. Have you ever received pretrial diversion or similar disposition for any federal, state, or municipal offense? 4. Have you ever received probation or community supervision for any federal, state, or municipal offense? Yes_ No If Yes, please provide further details below. Attach extra pages if needed. 5. Have you ever been convicted of any criminal offense in a country outside the jurisdiction of the United States? Country: State/Province: of Offense: Details of Conviction: 6. As of the date of this consent form, do you have any pending charges against you? Yes No If Yes, please provide further details below. Attach extra pages if needed. State: County: of Arrest: Details of Pending Charges: I acknowledge that a facsimile or copy of this document shall have the same validity, force and effect as the original. Lone Star College System policy IV.A.1.07 1.11 addresses the operation of criminal history background checks within the LSCS. HR120114