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Application for Volunteers

2. Name

4. Address

6. City

7. State

8. Zip

10. Email Address

11. Phone

15. Days/Times You Would Be Available

    Sunday through Saturday; a.m. vs. p.m.

17. Please explain why you are interested in volunteering and if you have any special qualifications.

21. References
    Please list three references that we may contact regarding your work experience.

    Please list three references that we may contact regarding your work experience.

23. Reference 1

25. Name

27. Phone

28. Years Acquainted

30. Reference 2

32. Name

34. Phone

35. Years Acquainted

37. Reference 3

39. Name

41. Phone

42. Years Acquainted

46. Acknowledgment

    As a volunteer for the City of Westbrook I understand that I will not receive compensation for my services and that I am ineligible for benefits provided to city employees.

    1. I acknowledge
48. Contact Information
    For more information, please contact Human Resources at 207-854-9105.

    For more information, please contact Human Resources at 207-854-9105.

52. Volunteer Authorization and Release Form

54. Have you been convicted of a felony?

    1. Yes

    1. No

56. If yes, please provide the date(s) and nature of the felony.

58. Have you been convicted of a misdemeanor?

    1. Yes

    1. No

60. If yes, please provide the date(s) and nature of the misdemeanor.

62. Do you have a criminal case(s) pending against you?

    1. Yes

    1. No

64. If yes, please provide details about the nature of the charges.

68. Authorization of Background Investigation

    I hereby authorize the City of Westbrook to conduct an Investigation through the Motor Vehicle Division of the Maine Secretary of State for vehicle related record checks and through the Maine State Bureau of Identification or other source for criminal record checks. I hereby release the City of Westbrook from any and all liability for any claims or damages arising out of its investigation as outlined above or from the City's use of the information provided.
    
    I understand that if l do not agree to execute this, I will not be considered a volunteer for the City of Westbrook, and that any misrepresentation of information contained herein will preclude me from consideration as a volunteer with the City of Westbrook.

    1. I authorize a background investigation.
70. Other Names Used, if any

72. Date of Birth

73. Phone

77. Residential Addresses for the Past 7 Years

79. Residential Address 1

81. Street Address

83. City

84. State

85. Zip

87. Residential Address 2

89. Street Address

91. City

92. State

93. Zip

97. Authorization of Background Investigation
    Applicants under 18 years of age must have a parent or court appointed guardian sign this authorization of background investigation.

    Applicants under 18 years of age must have a parent or court appointed guardian sign this authorization of background investigation.

99. Parental Consent
    I hereby give my consent for the above-mentioned applicant to have a background check performed on him/her. Furthermore, I hereby understand and agree to the conditions of this release as described above.

    I hereby give my consent for the above-mentioned applicant to have a background check performed on him/her. Furthermore, I hereby understand and agree to the conditions of this release as described above.

101. Parent/Guardian Signature

102. Parent/Guardian Name

104. Date

Leave This Blank:


106. 1. Receive an email copy of this form.
107. Email address

     This field is not part of the form submission.

108. Submit Submit and Print

* indicates a required field