VolunteerAppForm .pdf

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Title: Microsoft Word - Volunteer Application Form revision 3.22.12.doc

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Volunteer Application Form
Name:_________________________________________________________________________
Last
First
Middle
_______________________________________________________________________________
Address: Street
_______________________________________________________________________________
City, State, and Zip
Home Phone: _______________________________Business______________________________
Cell Phone:__________________________________________ Date of Birth ________________
Email address:________________________________________
Contact Person (in case of emergency):______________________________
Contact’s Phone Number: ________________________________________
1) List past work experience (including volunteer work.) Highlight any experience that you feel might be
applicable to library work.
_______________________________________________________________________________________
_______________________________________________________________________________________
2) List other skills and special knowledge or education you have which might be beneficial to the library.
_______________________________________________________________________________________
_______________________________________________________________________________________
3) Why are you interested in volunteering at Lake Elmo Public Library?
_______________________________________________________________________________________
_______________________________________________________________________________________
4) What part of the library operation are you interested in -- such as shelving books, checkout, covering
book jackets, fundraising, event support, technology, woodworking and repair, children’s activities, other?
______________________________________________________________________
5) Do you have a medical condition or mobility restriction that would limit your ability to perform certain
tasks without reasonable accommodation? YES_____ NO_____ If yes, please explain.

Lake Elmo Public Library Volunteer Application, pg. 2
Time Commitment: Most volunteer positions at the library require an on going commitment of 6 months or
more. Special projects may be available for less than a 6- month commitment. Please indicate how long you
would like to commit to the library.
___Less than 6 months ___6 months or more ___school or community service requirement
When are you available? Please check all that apply.
Sunday Monday Tuesday Wednesday Thursday Friday Saturday
Morning________________________________________________________________
Afternoon_______________________________________________________________
Evening ________________________________________________________________
References: Please list two employers, supervisors, teachers or other non-relatives we may contact for a
reference.
1.Name __________________________________
Occupation ______________________________
Phone___________________________________
2. Name __________________________________
Occupation ______________________________
Phone___________________________________
If you are 18 or over, have you ever been convicted for a violation of the law other than a minor traffic
ticket? No___ Yes___ (Provide details on the reverse side of this sheet.)
I certify that all statements made on this application are true, complete and correct to the best of my
knowledge and belief. I understand these statements are subject to verification. I understand that
falsification of this application will disqualify me from selection or result in dismissal. My submission of this
application is my consent for Lake Elmo Public Library and its agents to conduct all necessary checks
needed to meet the requirements for this position and my agreement to supply all required information.
Signature of Applicant _________________________________________Date_______
Return this application to Lake Elmo Public Library, or mail to:
Volunteer Program
Lake Elmo Public Library
3537 Lake Elmo Ave,. N. Suite 130
Lake Elmo, Minnesota 55042

Lake Elmo Public Library Volunteer Application, pg. 3
Lake Elmo Public Library will not discriminate against or harass any volunteer because of race, creed,
religion, national origin, sex, mental or physical disability, age, marital status, or status with regard to public
assistance, sexual orientation, familial status or politics.
TENNESSEN WARNING
This application is to assist in the process of referring you to the Lake Elmo Public Library for a
possible position as a volunteer. Certain information requested on the application is private, that is, it may
be released only to you or the Lake Elmo Public Library.
PRIVATE DATA: WHY WE ASK FOR THE INFORMATION AND WHAT MAY HAPPEN IF YOU
DON’T PROVIDE THE INFORMATION
Name To distinguish you from all other applicants. Failure to provide information may be cause for
rejecting an application.
Street Address To be able to send you notices. Failure to provide information may be cause for rejecting an
application.
Telephone Numbers To be able to contact you to determine your availability for an interview.
Conviction Record To determine whether we may legally accept an application from you. To determine
whether your record may be a job-related conviction.
Approved LE Library Board April 4, 2012


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