Apply | Centerville Public Library

Personal Information

Name*

First Last

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Phone*

Email*

References

Name

First Last

Years known

Phone

Email

Relationship

Best method of contact

Phone
Email

Have you ever been convicted of a felony?*

Yes
No

If yes, please describe.

Please list any health issues that you have that could affect your volunteer work:*

Please list your computer skills:*

How often would you like to volunteer?*

On a regular basis
For special events only

If you checked on a regular basis, how regularly?

Once a week
Twice a week
Twice a month
Other

Other:

Task/Role Interest and Experience

For each task/role, please indicate whether or not you have experience with or interest in.

Genealogy

Interest
Experience

Office Tasks

Interest
Experience

Children's Programs

Interest
Experience

Organizing Events

Interest
Experience

Shelving

Interest
Experience

Graphic Design

Interest
Experience

Publicity

Interest
Experience

Reading Aloud

Interest
Experience

Tutoring

Interest
Experience

Processing New Books

Interest
Experience

Decorating

Interest
Experience

Data Analysis

Interest
Experience

Fundraising

Interest
Experience

Statement of Confidentiality*

Library patron information is considered confidential. Information pertaining directly or indirectly to any staff member, patron, or another volunteer shall not be repeated or discussed inside or outside the library.

I agree to the Statement of Confidentiality.

Volunteer Waiver of Liability*

Iunderstand that I will not be covered by Worker’s Compensation. If I use my own car while performing volunteer duties, I am responsible for my own insurance. By signing this application, I release the Centerville Center Township Public Library from any liability with respect to any personal injury, illness, death, or property damage that may result from my volunteer activities.

I agree to the Volunteer Waiver of Liability.

Volunteer Compensation Understanding*

I understand that I will not be paid for my services as a volunteer, and I expect no compensation.

I agree to the Volunteer Compensation Understanding

Signature*

Please type your full name.

Date Signed*

Parent or Guardian's Signature

(Required if Applicant is under age 18)

Date Signed by Parent or Guardian

About

Volunteering: Apply

Volunteer Application

Personal Information

References

Task/Role Interest and Experience