"Volunteer Application Form" - City of White House, Tennessee

Volunteer Application Form is a legal document that was released by the Human Resources Department - City of White House, Tennessee - a government authority operating within Tennessee. The form may be used strictly within City of White House.

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City of White House Volunteer Application
 
The City of White House is an equal opportunity employer and considers volunteers without regard
to race, religion, gender, national origin, age, disability or any other legally protected status.
Volunteer Position(s): _________________________________________________________________
Name ________________________________
Social Security Number _______________________
Street Address _______________________________________________________________________
City ______________________________ State _______________________ Zip Code ___________
Telephone Number(s) __________________________________________________________________
Email Address ________________________________________________________________________
Are you at least 18 years of age? *
Yes ___
No ___
Are you related to a current COWH employee?
Yes ___
No ___
If yes, give name and relationship: ________________________________________________
Have you ever been employed by the COWH?
Yes ___
No ___
If yes, give dates of employment: _________________________________________________
Have you ever been convicted of a crime, had adjudication of a crime withheld or pled nolo
contendere (no contest) to a crime?
Yes ___
No ___
If yes, please explain: ___________________________________________________________
References:
Name
Telephone Number
Years Known
Emergency Contact Information:
Name: ________________________
Relationship: ________________ Phone (
)_____________
City of White House Volunteer Application
 
The City of White House is an equal opportunity employer and considers volunteers without regard
to race, religion, gender, national origin, age, disability or any other legally protected status.
Volunteer Position(s): _________________________________________________________________
Name ________________________________
Social Security Number _______________________
Street Address _______________________________________________________________________
City ______________________________ State _______________________ Zip Code ___________
Telephone Number(s) __________________________________________________________________
Email Address ________________________________________________________________________
Are you at least 18 years of age? *
Yes ___
No ___
Are you related to a current COWH employee?
Yes ___
No ___
If yes, give name and relationship: ________________________________________________
Have you ever been employed by the COWH?
Yes ___
No ___
If yes, give dates of employment: _________________________________________________
Have you ever been convicted of a crime, had adjudication of a crime withheld or pled nolo
contendere (no contest) to a crime?
Yes ___
No ___
If yes, please explain: ___________________________________________________________
References:
Name
Telephone Number
Years Known
Emergency Contact Information:
Name: ________________________
Relationship: ________________ Phone (
)_____________
* Volunteers under the age of 18 must have parental consent. All legal guardians must sign/initial
application form accordingly.
Authorization/Agreement:
By my signature below I certify that all of the information and statements provided by me in and
with this application are true and correct. It is understood and agreed upon that any
misrepresentation or omission by me in this application will be sufficient cause for cancellation of
this application and forfeiture of my opportunity to volunteer with the City of White House. ____
Initial
Release of Liability:
In consideration of being allowed to participate as Volunteer for the City of White House, I
acknowledge that working on municipal projects may be unintentional hazardous activities and I
assume all risks associated with this volunteer opportunity. I waive all claims for damages against
the city and against its officers and employees for injury to my person or property, including death
and destruction that may arise from activities. I further understand that I am working as a
volunteer, not an employee, and I am not entitled to any compensation for the volunteer activities I
perform. I release the city and its officers and employees and agree to hold them harmless from
any such liability. _____
initial
____________________________________
_____________________
Volunteer Signature
Date
Parental Consent and Release of Liability: (If applicable)
In consideration of our child, __________________________________, being allowed to participate
in a Volunteer capacity for the City of White House, we acknowledge that working on municipal
projects may be unintentionally hazardous. Nevertheless, we grant permission for our child to
participate in this activity and assume all the risks associated with this work. We waive all claims
for property, including death and destruction and resulting injuries and damages that may arise
from this activity. We further understand that our child is working as a volunteer, not an employee,
and is not entitled to any compensation for the volunteer activities he/she performs. We release
the city and its officers and employees and agree to hold them harmless from any such liability.
This agreement shall remain in force until we revoke it in writing.
___________________________________
____________________________________
Parent or Guardian Signature
Parent or Guardian Signature
___________________________________
_____________________________________
Print Name
Date
Print Name
Date
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