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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.
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.
52. 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.
54. Other Names Used, if any
56. Date of Birth
57. Phone
61. Residential Addresses for the Past 7 Years
63. Residential Address 1
65. Street Address
67. City
68. State
69. Zip
71. Residential Address 2
73. Street Address
75. City
76. State
77. Zip
81. Authorization of Background Investigation
    Applicants under 18 years of age must have a parent or court appointed guardian sign this authorization of background investigation.
83. 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.
85. Parent/Guardian Signature
86. Parent/Guardian Name
88. Date
Leave This Blank:


90. 1. Receive an email copy of this form.
91. Email address

    This field is not part of the form submission.

92. Submit Submit and Print

* indicates a required field