Personal Information

Last Name / First Name / M.I. / DAY PHONE / EVENING PHONE
Street Address / City / State
OH / Zip Code / COUNTY

Ifunder 18 years of age, give name of parent or guardian

Last Name / First Name / M.I.

Person to notify in case of emergency

Last Name / First Name / M.I. / DAY PHONE / EVENING PHONE
Street Address / City / State / Zip Code

Employment

current employer / length of employment
from__/____to__/____
job title and duties performeD

Education

highest education level achieved / school
certifications
list any qualifications, skills, or interests, particularly those applicable to boating

Boating Experience (in years)

Sailing / Paddling / Powerboating / Rowboat / Water Skiing

Swimming Ability (check one)

Excellent Good Nonswimmer

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Please list two personal references:

Last Name / First Name / M.I. / occupation / PHONE
Street Address / City / State
OH / Zip Code
Last Name / First Name / M.I. / occupation / PHONE
Street Address / City / State
OH / Zip Code

The Ohio Department of Natural Resources does not discriminate on the basis of race, color, national origin, sex, religion, age or disability in employment or the provision of services.

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Areas of Interest(check all that apply)

Administrative/Clerical

Boating Safety Classes

Law Enforcement Support

Ohio Boating Education Course Instructor

River and Water Rescue

Scenic Rivers Program

Skill Development in Powerboating

Skill Development in Sailing

Skill Development in Paddling

Special Events/Ohio State Fair

Stream Quality Monitoring

Any/Other:

Period of Availability:

From__/____to__/____

Hours you would be available:

Sunday:

Monday:

Tuesday:

Wednesday:

Thursday:

Friday:

Saturday:

The Ohio Department of Natural Resources does not discriminate on the basis of race, color, national origin, sex, religion, age or disability in employment or the provision of services.

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Please explain why you want to participate in the ODNR Division of Parks and Watercraft Volunteer Program.

What do you expect to gain from this experience?

Signature of Applicant / Date

The Ohio Department of Natural Resources does not discriminate on the basis of race, color, national origin, sex, religion, age or disability in employment or the provision of services.

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