Volunteer Interest Form

Today's Date

First Name

Last Name

Address

Address 2

City/Town

State/Province

ZIP/Postal Code

Phone Number

Email Address

Library Preference & Availability

Library Preference?

Cedaredge

Crawford

Delta

Hotchkiss

Paonia

Literacy

I am interested in volunteering for at least one (1) year:

On a regular basis (weekly, biweekly)

For special events (programs, fundraisers, etc.)

Days/Times you are available

Hours/Week

Education & Experience

Highest level of education completed:

Degree or Area of Study

Work Experience (include volunteer and military service):

Last or present Employer

Position

City/Town

State/Province

Previous Employer

Position

City/Town

State/Province

Personal References

(not present employer or relative):

First Name

Last Name

Phone Number

Relationship

First Name

Last Name

Phone Number

Relationship

Have you ever been convicted of a criminal offense? (Please check one.)

Yes

No

If yes, please give date, place, and nature of the charge for which you were convicted.

In case of emergency, please contact:

First Name

Last Name

Phone Number

Relationship

Please sign below when you have read and understood all statements.

I certify that all statements made in this Volunteer Application are true and correct and have been given voluntarily. I understand that this information may be disclosed to any party with legal and proper interest, and I release Delta County Public Library District from any liability for supplying such information.
I understand that the Delta County Public Library District reserves the right to screen volunteers and will not accept as a volunteer anyone who would jeopardize any aspect of library service or safety of library staff and patrons.
I agree to give prior notification to the Library if I cannot keep my scheduled date and time of service.
I give permission to be photographed and/or videotaped for the sole purpose of non-commercial educational and/or promotional use, and I understand that I am not entitled to compensation for that service.
I understand that I will not be paid for my services as a volunteer, and I am giving my time freely to the Delta County Public Library District.
I understand that by volunteering, I am not guaranteed any special consideration for any future permanent job positions with the Delta County Public Library District.

I understand and agree to the terms listed above (please sign).

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