Please Answer All Questions Completely and Accurately in Your Own Handwriting

Memphis Zoo

VOLUNTEER APPLICATION

Fill out application in your own handwriting and send completed application to: Volunteer Office, Memphis Zoo, 2000 Prentiss Place, Memphis, TN 38112. For additional information, please call (901) 333-6654.

Please answer all questions completely and accurately in your own handwriting.

Last Name: / First
Name: / Middle Initial:
Have you ever been know by any other name(s) that MZS will require to verify any of the information contained in this application? Circle one: NO YES
If Yes, please list those names:
Current Street Address: / Apt. Number:
City: / State: / Zip:
If you have been in the Memphis area for less than 10 years please provide this information in the spaces below. How long have you been in the Memphis area:
City:
/ State: County: / Zip:
Primary Phone: / Secondary Phone: / Primary Email:
Date of Birth:
(This is required to conduct background check on all volunteer applicants.) / ____/____/____ / Social Security Number: (This is required to conduct background check on all volunteer applicants.) / _____-____-______
Highest level of education completed: / Degree earned:
Other certifications or training:
Current Employer: / Position held:
Work Telephone: / Ext. #: / Work Email:

If necessary, may we call or email you at work? __ Yes __ No

Are you currently a member of the Memphis Zoological Society? __ Yes __ No

If yes, please list your membership number:

Have you ever done any volunteer work before? __ Yes __ No

If yes, please provide the organization(s) name, volunteer coordinator’s name, address, phone number, dates of service, and description of volunteer work performed. (Please attach separate sheet if more space is needed)

Why do you want to volunteer at the Memphis Zoo and Aquarium? (Please attach separate sheet if more space is needed)

Special talents and skills (Please attach separate sheet if more space is needed):

How did you hear about volunteer opportunities at the Memphis Zoo? (Please attach separate sheet if more space is needed)

I enjoy working with the following age groups: Please circle your response.

Pre-School /

Elementary

Teenage

Young Adult / College

Adult

Senior

Which days are you generally available? Please circle your response.

Monday / Tuesday / Wednesday / Thursday / Friday / Saturday / Sunday

What times are you generally available? Please circle your response.

Morning / Afternoon / Night

How many hours would you like to obtain? ______hours per ______(week/month)

Do you have any physical conditions that we should be aware of in case of a medical emergency?

Emergency Contact: Name and relationship to you: / Home Phone: / Work Phone:
Emergency Contact: Name and relationship to you: / Home Phone: / Work Phone:

List three (3) persons who are not related to you and who have definite knowledge of your qualifications and skills for the volunteer position(s) for which you are applying.

Name: / Address: / Occupation: / Telephone: / Relationship:
1.
2.
3.

Have you ever been convicted of a crime? __ Yes __ No

If yes, list all convictions, showing offense and date:

Are there any criminal charges pending against you? __ Yes __ No

If yes, please explain:

I am interested in the following volunteer opportunities: (Check as many as apply.)

_____ Animal Area—Please specify:

______

_____ Clerical / Office Assistance

_____ Development / Membership

_____ Docent

_____ Education

_____ Horticulture

_____ Nutrition Center

_____ Record Keeping

_____ Retail Gift Shop

_____ Security

_____ Seasonal

_____ Special Events

_____ Guest Relations

_____ Other – Please specify: ______

Authorization for Release of Information

I understand that the information on my volunteer application is subject to check and verification by Memphis Zoological Society doing business as Memphis Zoo, and that my previous and present employers, organizations, and volunteer associations may be asked for information as to my character and record with them.

I hereby grant permission to Memphis Zoological Society doing business as Memphis Zoo to contact these employers, organizations, and volunteer associations, and further, I hereby authorize my former and / or present employers, organizations, and volunteer associations to give any information as to my character and employment record with them.

I also grant permission to Memphis Zoological Society doing business as Memphis Zoo to obtain information from and / or copy police and court records in order to conduct a pre-volunteer investigation on me.

I hereby release from all liability and damages those individuals, companies, organizations, or agencies who provide information as stated above.

Should I become a volunteer, I agree to comply with all rules and regulations of Memphis Zoological Society doing business as Memphis Zoo.

I certify that the information given by me in this volunteer application is true and complete.

Signature:
/ Date:
Guardian
Signature:
(under 18) / Date:

Please return this form to: Volunteer Office, Memphis Zoo, 2000 Prentiss Place, Memphis, TN 38112.