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Volunteer Application

2. Date Received
   Date Received
4. The City of Snoqualmie operates a volunteer program that provides services organization-wide. The purpose of the program is to enable the City to take advantage of the extraordinary reserve of knowledge, talent, and skill possessed by volunteers within our community and to capitalize on these abilities to augment City services. The intent is also to provide a program which involves interested residents in local government while providing them the opportunity to perform work of value to the community.
   
   The volunteer application is designed to give applicants an opportunity to share their background, experience, interests and skills, enabling the City to make the best possible volunteer placement.
6. First Name
7. Last Name
9. Middle Name
11. Address
13. City
14. State
15. Zip Code
17. Home Phone Number
18. Message Number
20. Work Phone Number
21. Email Address
23. Are you over the age of 18?

    1. Yes
    2. No
24. If you are not over the age of 18, provide date of birth
    If you are not over the age of 18, provide date of birth
26. Do you have, or can you obtain, a valid Washington State Driver’s License?

    1. Yes
    2. No
27. Availability

    1. Long-term
    2. Short-term
    3. Special Project
29. Check the days you can be available for volunteer work

    1. Sunday
    2. Monday
    3. Tuesday
    4. Wednesday
    5. Thursday
    6. Friday
    7. Saturday
31. Are you currently certified in CPR?

    1. Yes
    2. No
32. Are you currently certified in First Aid?

    1. Yes
    2. No
34. In what particular areas of volunteer work are you interested?
36. What general skills/experience/education would you like to share in your volunteer work?
38. Criminal Convictions
40. Have you been convicted of a felony or released from prison within the last ten 10, or have been convicted of a misdemeanor other than minor traffic offenses within the past 3 years?

    1. Yes
    2. No
42. If yes, please explain
44. Do you have any medical conditions physical or emotional that should be taken into consideration in arranging volunteer assignments?

    1. Yes
    2. No
46. If yes, please explain
48. In case of emergency please contact
49. Phone number of emergency contact
51. References
    Do not list relatives
53. First Name
54. Last Name
56. Address
58. City
59. State
60. Zip Code
62. Phone Number
66. First Name
67. Last Name
69. Address
71. City
72. State
73. Zip Code
75. Phone Number
79. First Name
80. Last Name
82. Address
84. City
85. State
86. Zip Code
88. Phone Number
90. Notice to Volunteers
    Volunteers are not considered to be City of Snoqualmie employees. Injury Compensation is provided through the Department of Labor and Industries. Volunteer service is considered to be creditable work experience. The data furnished on this form is furnished voluntarily and will be used to contact, interview and place volunteers.
92. Signature is Required
    To the best of my knowledge, the information herein is true and complete. I understand that falsification of this application is grounds for dismissal as a volunteer. Further I give permission for an authorized representative of the City to conduct a state patrol criminal background check in accordance with RCW 43.43.830-839 and to inquire of individuals about my ability to perform all aspects of the volunteer position for which I am being considered and I release the City of Snoqualmie and those individuals/institutions that provide information from any liability that may arise from the provision of this information.
    
    As a volunteer for the City of Snoqualmie, I am fully aware that the work associated with being a City Volunteer involves certain risks of physical injury or death. Being fully informed as to these risks and in consideration of my being allowed to participate in the City’s Volunteer Program, I hereby assume all risk of injury, damage and harm to myself arising from such activities or use of City facilities. I also hereby individually and on behalf of my heirs, executors and assignees, release and hold harmless the City of Snoqualmie, its officials, employees and agents and waive any right of recovery that I might have to bring a claim or a lawsuit against them for any personal injury, death or other consequences occurring to me arising out of my volunteer activities.
    
    I give permission to have my photo taken and used for publicity purposes by the City. I authorize any necessary emergency medical treatment that might be required for me in the event of physical injury and/or accident to me while participating in this program.
94. E-Signature
95. Date
    Date
97. If Under 18 Parent or Guardian’s E-Signature
98. Date
    Date
Leave This Blank:


100. 1. Receive an email copy of this form.
101. Email address

     This field is not part of the form submission.

102. Submit

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