Today’s Date: / Name (First Middle Last) / Are you over 18?
Yes No
Email: / Phone(s):
Street Address (including apartment number if any): / City, State, and Zip Code:
Best way to contact you?
Email Phone Other: / Do you have base access?
Yes No / Do you have access to government vehicles? Yes No
Do you have a CAC card:
Yes No / Base Status:
Military Retired Military Civilian Neither
Which volunteer activities are you most interested in? (check all that apply)
Natural Resources
- ORV Monitoring
- Piute Ponds
- Branch Park
- Other:
- Archaeology Lab
- Curation
- Fieldwork
- Other:
- Tours
- School Visits
- Earth Day
- Other:
- Program Organizing
- Clerical
- GIS
- Other:
What qualifications, skills, or experience would you bring to your volunteer work? (check all that apply)
Driver’s License
ATV Certification
GPSExperience / Wildlife Management
Hand/Power Tools
Map Reading / Photography
Writing/Design
Program Leadership / GIS
Other:
Would you like to supervise other volunteers and/or help coordinate events? Yes No
When are you usually available to volunteer?
Weekdays
Weekends
Mornings
Afternoons
Other: / This space is provided for additional comments:
I agree to receive the required safety training prior to performing any volunteer duties. Yes No
Emergency contact name: Emergency contact number:
Notice to Volunteer
Volunteers are recruited and accepted from the public without regard to race, creed, religion, age, sex, color, or national origin.Volunteers are not considered to be federal employees for any purpose other than tort claims and injury compensation. Volunteer services are not creditable for leave accrual or any other benefit;however, volunteer service is creditable toward work experience.
Privacy Act Statement
All information provided will be protected in accordance with the Privacy Act of 1974(Public Law 93-579, as codified in Title 5, United States Codes (U.S.C.), Section 552a, and published in Title 32, Code of Federal Regulations, Section 806B), and is authorized by Federal Statutes (5 U.S.C. 301 and 10 U.S.C. 8012). The information in this form will be used to contact applicants in order to interview, screen, and select volunteers for assignments. Furnishing this information is voluntary.
Signature (sign in ink—if applying electronically, you can sign at orientation) / Date
412th CEG Environmental Management Volunteer Program
120 North Rosamond Blvd, Edwards Air Force Base, California 93524-8060
Phone: 661-277-1401 Fax: 661-277-6145