VOLUNTEER APPLICATION
ClackamasCounty Business and Community Services
NorthClackamasParks and Recreation District
PLEASEPRINT CLEARLY
Name: ______Date: ______Address: ______City: ______Zip: ______
Telephone: Home______Work______Cell ______
E-mail: ______Birth Date: ____/____/____ Sex: ____M ____F
What interests you about volunteering? ______
When are you available to volunteer?
Number of hours per week:_____ Preferred days and time:______Days not available:______
Volunteer time commitment: _____3 Months _____6 Months _____1 Year _____Indefinitely
How did you hear about us? ______
Present/Previous volunteer experience ______
Present/Previous work history______
Do you have any health/physical restrictions? ______
Have you ever been convicted of a felony?YES NO If yes, explain______
Do you volunteer with any other Clackamas County Departments? YES NO
If so, please write down the Department______
(i.e., Sheriff’s Department, Social Services, CountyLibraries,
Mental Health, WES, Volunteer Connection, Dog Control, Corrections, Public Health,etc.).
This helps us eliminate duplication of volunteer insurance coverage.
For office use only:
Date app. received______Staff interviewer______
Date notified of Criminal check report______Date forms sent to Volunteer/Project Coord______
Date of orientation ______Volunteer placement______Location ______
FORM B-1
AREAS OF INTEREST
CLERICAL AND BUSINESS______Receptionist
______Host/Hostess
______Bookkeeping
______Planning and organizing
______Clerical/Phone/Filing
______Computer/Data entry
______Tax preparation
______Legal/Financial
____
____ ENVIRONMENTAL/PARKS
______Park clean-up and trail
renovation
______Adopt-A-Park- beautify your park! park!
______Other: / ADMINISTRATION
______Committee member
______Board member
______Public speaking
______Fundraising
______Business contacts
______Filing
HE HEALTH AND MEDICAL
______Support group facilitator
______Respite program aides
______Health clinic hosts
______RN (current license)
____ OTHER ______ / SPECIAL INTEREST OR SKILLS_
______Trip and travel planning
______Arts and crafts
______Languages
______Tutoring
______Graphic arts
______Music vocal/Instrument
FRIENDS OF MILWAUKIECENTER
______Bingo
______Board Members
______Special Events
_____Quilting
______Gift shop sales
TRANSPORTATION
______Bus washer
______Grocery shopping asst.
AQUATICPARK
______Pool maintenance
______Swim instructor aide
______Welcome/Event greeter
______Special events
______Event registrar / RECREATION
______Cheerleading coach
______Coaching (Mini-Hoopers)
______Special events
______Rec. mobile assistant
______Photography
______Recreation assistant / NUTRITION
______Food server
______Bistro deli
______Meals on Wheels driver/runner
______Food packer – a.m. and p.m.
______Dish washer
______Special events
For Office Use Only / Transportation Source:
______Walk __ Carpool/Van __Bus ___Drive car ___Get ride
___ bike
Primary language spoken______
Race/Ethnicity (optional):
___African Amer. ___Am. Indian ___Hispanic
___Caucasian ___ Asian ___ Pacific Islander
___Multi. ___Other______
All information on this application is true to the best of my knowledge. I understand that if I use my personal automobile to and from my volunteer assignment that I will agree to keep in effect automobile liability insurance equal to or greater than the minimum required by the State of Oregon. I understand that all information used in my volunteer role is confidential and I will respect that confidentiality. I release, indemnify and hold harmless ClackamasCounty andNorthClackamasParks and Recreation District, its officers, agents and employees from any and all claims, actions and demands that may arise from my actions as a volunteer.I also understand I can be terminated at the discretion of the agency at any time.
Signed: ______Date: ______
If applicant is a minor, parent or guardian must sign and agree to the above statement and sign
below.
Signed: ______Date: ______
RETURN THIS APPLICATION TO: Clackamas CountyBusiness and Community Services/NCPRD
150 Beavercreek Road, Oregon City, OR 97045 (503) 742-4353
Revised 1/6/11 by PG