"Volunteer Application Form - Broward County Library" - Broward County, Florida

Volunteer Application Form - Broward County Library is a legal document that was released by the Board of County Commissioners - Broward County, Florida - a government authority operating within Florida. The form may be used strictly within Broward County.

Form Details:

  • Released on November 1, 2015;
  • The latest edition currently provided by the Board of County Commissioners - Broward County, Florida;
  • Ready to use and print;
  • Easy to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of the form by clicking the link below or browse more documents and templates provided by the Board of County Commissioners - Broward County, Florida.

ADVERTISEMENT
ADVERTISEMENT

Download "Volunteer Application Form - Broward County Library" - Broward County, Florida

Download PDF

Fill PDF online

Rate (4.7 / 5) 25 votes
Page background image
RESET FORM
VOLUNTEER APPLICATION
VOLUNTEER APPLICANT INFORMATION
Name:
Date of Birth:
Current Address:
City:
State:
Zip Code:
Phone 1:
Phone 2:
Email:
AREA OF INTEREST
Language spoken other than English:_____________________________________
Preferred Library Location: _______________________
Hours and days available to Volunteer:_______________________________________________
Interests: Adults___ Teens___ Other___
EMERGENCY CONTACT INFORMATION
Name:
Phone Number:
Relationship:
CRIMINAL BACKGROUND CHECK
TH
SINCE YOUR 18
BIRTHDAY, HAVE YOU BEEN CONVICTED OF ANY VIOLATION OF THE LAW, OTHER THAN MINOR TRAFFIC
OFFENSES, OR PLED NOLO CONTENDERE (NO CONTEST) TO CRIMINAL CHARGES, EVEN IF ADJUDICATION WAS WITHHELD?
Yes____ No ____ If Yes, Please Describe:
Name of Offense _________________________________________________
MISDEMEANOR
FELONY (Check One)
Name of and Location of Court ________________________________________________________________________________________
Disposition of Case ____________________________________________________________________ Date: _______________________
N ote: One conviction w ill not autom atically keep you from volunteering at a Brow ard County Library location. M ore than one conviction (of
any kind) or a conviction for other than driving under the influence (DUI), a traffic violation, unlaw ful assem bly, or shoplifting (only if you
w ere a m inor) w ill disqualify you.
SIGNATURES
The above information is accurate and correct to the best of my knowledge.
Signature of Applicant:_______________________________________________________________
Date:__________________________
*****FOR DIVISION USE ONLY*****
Work Location: ________________________ Site Coordinator: ________________________________Date: __________
Check all that Apply:
Criminal Background Information Form and Photo ID Attached _____ Yes _____No
Parental Consent Form Attached (if applicable) ______ Yes _____No
Community Service Volunteer Form (if applicable) ___Yes _____No
Was this applicant approved for volunteer work? ____Yes ____No
A Service of the Broward County Board of County Commissioners
RESET FORM
VOLUNTEER APPLICATION
VOLUNTEER APPLICANT INFORMATION
Name:
Date of Birth:
Current Address:
City:
State:
Zip Code:
Phone 1:
Phone 2:
Email:
AREA OF INTEREST
Language spoken other than English:_____________________________________
Preferred Library Location: _______________________
Hours and days available to Volunteer:_______________________________________________
Interests: Adults___ Teens___ Other___
EMERGENCY CONTACT INFORMATION
Name:
Phone Number:
Relationship:
CRIMINAL BACKGROUND CHECK
TH
SINCE YOUR 18
BIRTHDAY, HAVE YOU BEEN CONVICTED OF ANY VIOLATION OF THE LAW, OTHER THAN MINOR TRAFFIC
OFFENSES, OR PLED NOLO CONTENDERE (NO CONTEST) TO CRIMINAL CHARGES, EVEN IF ADJUDICATION WAS WITHHELD?
Yes____ No ____ If Yes, Please Describe:
Name of Offense _________________________________________________
MISDEMEANOR
FELONY (Check One)
Name of and Location of Court ________________________________________________________________________________________
Disposition of Case ____________________________________________________________________ Date: _______________________
N ote: One conviction w ill not autom atically keep you from volunteering at a Brow ard County Library location. M ore than one conviction (of
any kind) or a conviction for other than driving under the influence (DUI), a traffic violation, unlaw ful assem bly, or shoplifting (only if you
w ere a m inor) w ill disqualify you.
SIGNATURES
The above information is accurate and correct to the best of my knowledge.
Signature of Applicant:_______________________________________________________________
Date:__________________________
*****FOR DIVISION USE ONLY*****
Work Location: ________________________ Site Coordinator: ________________________________Date: __________
Check all that Apply:
Criminal Background Information Form and Photo ID Attached _____ Yes _____No
Parental Consent Form Attached (if applicable) ______ Yes _____No
Community Service Volunteer Form (if applicable) ___Yes _____No
Was this applicant approved for volunteer work? ____Yes ____No
A Service of the Broward County Board of County Commissioners
Reset Form
PARENTAL PERMISSION FOR VOLUNTEER
(Required for applicants under the age of 18 years)
Volunteer’s Name: ________________________________________ Date of Birth: _________
(Last)
(First)
Address: _____________________________ City: ____________________ Zip:__________
Name of
Parent/Guardian: ______________________________________________________________
Home Phone: ________________________________ Work Phone: _____________________
E-mail Address: ______________________________________________________________
CONTACT IN CASE OF EMERGENCY
_________________________
_____________________
___________________
________________
Name
Relationship
Home Phone
Work Phone
_________________________
_____________________
___________________
________________
Name
Relationship
Home Phone
Work Phone
VOLUNTEER ASSIGNMENT
Library Location: ______________________________________________________________
Hours/Days: _________________________________________________________________
Method of Transportation: _______________________________________________________
PARENTAL PERMISSION
My son/daughter/ward ________________________________ has my permission to participate
in the volunteer program at the following library location _______________________________.
I am aware of my child’s schedule, possible volunteer job duties, and expected rules of behavior
and am in accordance with them.
My son/daughter/ward has my permission to sign the Request for Criminal Background
Information (Form V2), which authorizes Broward County to conduct the required criminal
background screening.
______________________________________________
____________________
Signature of Parent/Guardian
Date
BROWARD COUNTY BOARD OF COUNTY COMMISSIONERS
Finance and Administrative Services Department
Risk Management Division | Safety & Occupational Health Section
ACKNOWLEDGEMENT, AUTHORIZATION AND REQUEST
INSTRUCTIONS
FOR CRIMINAL BACKGROUND INFORMATION
ACKNOWLEDGMENT AND AUTHORIZATION FOR BACKGROUND CHECK AND RECORD RELEASE
Check appropriate box for: Employment, Volunteer or Community Service Worker
Intern
Volunteer
Community Service Worker (court ordered)
I acknowledge receipt of the separate documents entitled BACKGROUND INVESTIGATION DISCLOSURE and A SUMMARY OF
YOUR RIGHTS UNDER THE FAIR CREDIT REPORTING ACT, and certify that I have read and understand both of the documents. I
hereby authorize the obtaining of “consumer reports” and/or “investigative consumer reports” by Broward County at any time after receipt
of this Authorization and throughout my employment or period of volunteer service, if applicable. To this end, I hereby authorize, without
reservation, any law enforcement agency, administrator, state or federal agency, institution, school or university (public or private),
information service bureau, employer, or insurance company to furnish any and all background information requested. These searches
will be conducted by Edge Information Management, Incorporated, 1682 W. Hibiscus Blvd., Melbourne, Florida 32901,
1-800-725-3343, www.edgeinformation.com and/or American Prestige Screening, P.O. Box 550674, Atlanta, GA 30355; Telephone
(888) 943-8985, and/or Broward County, itself. I agree that a facsimile (“fax”), electronic or photographic copy of this Authorization shall
be as valid as the original.
PERSONAL INFORMATION – ALL SPACES MUST BE COMPLETED
First
Middle
Last
Name: ________________________
Name: _______________
Name: __________________________________ Suffix: ______
Other Prior Names/Maiden Names/Aliases: _________________________________________________________________________
DOB: _________ / __________ / _____________
Gender:
Male
Female
_________
_______
__________
mm
dd
yyyy
Social Security Number
Race: (Check One)
White-Not Hispanic
Black-Not Hispanic
Hispanic
Asian/Pacific Island
American Indian/Alaskan Native
Current Address: ______________________________________________________________________________________________
How long have you lived in Florida? _________
_________ Driver’s License: _____________________
____
_____________
Years
Months
License Number
State
Expiration Date
Previous Addresses: ___________________________________________________________________________________________
Out of the state of Florida. Must be completed if you have lived in Florida for less than 10 years.
CRIMINAL RECORD (if any)
Since your 18th birthday, have you been convicted of or entered a plea of guilty or nolo contendre (no contest) to any violations of law.
You must include all felonies and misdemeanors, other than non-criminal traffic offenses, even if adjudication was withheld?
Yes
No If yes, please provide the following information: (use a separate sheet of paper if multiple records exist)
Offense: __________________________________________________________________________
Misdemeanor
Felony
Name & Location of court: ______________________________________________________________________________________
Court Disposition: ___________________________________________________________________
Date: ___________________
Note: A conviction does not automatically disqualify you. The nature of the offense, how long ago it occurred, relationship to your duties and agency assigned, etc. will be given consideration.
Printed Name: _______________________________________________________________________________________________
_________________________________________________________________
Date: ____________________________
SIGN ►
Candidate/Volunteer Signature
ACKNOWLEDGEMENT/AUTHORIZATION BACKGROUND REQ FORM (Rev. November 2015)
Page 1 of 2
BROWARD COUNTY BOARD OF COUNTY COMMISSIONERS
Finance and Administrative Services Department
Risk Management Division | Safety & Occupational Health Section
ACKNOWLEDGEMENT, AUTHORIZATION AND REQUEST
INSTRUCTIONS
FOR CRIMINAL BACKGROUND INFORMATION
Applicant's Name: _____________________________________________________________________________________________
To BE COMPLETED BY THE SUPERVISOR/PREPARER
Consistent with Broward County policies, an employee may not work in a position which supervises, is supervised by, or influences the
activity of a relative or a spouse employed by Broward County, and may not be promoted to such a position.
Does the candidate or volunteer have a relative or spouse working in this Agency who would supervise, be supervised by, or influence
the candidate or volunteer? (check one)
Yes
No
I certify that I have complied with the provisions of Broward County’s rule of employment of relatives.
_________________________________________________________________
Date: ____________________________
SIGN ►
Signature
MUST BE COMPLETED BY THE HIRING MANAGER
Intern Volunteer or CSW (circle one)
N/A
Job Title: ____________________________________________
BPN: ________________________________________________
N/A
Job Requisition #: _____________________________________
Will applicant work with children as described in applicable Florida Statutes?
Yes
No
Will applicant handle currency (checks, money orders and/or cash)?
Yes
No
Libraries
Division: ______________________________________________ Branch: _______________________________________________
Volunteer
Coordinator: _______________________________________________________________Work Phone: _______________________
_________________________________________________________________
Date: ____________________________
SIGN ►
Signature
Email
RISK MANAGEMENT / HUMAN RESOURCES USE ONLY
Qualified
Offer Withdrawn
Not Qualified
_________________________________________________________________
Date: ____________________________
SIGN ►
Risk Management Signature
ACKNOWLEDGEMENT/AUTHORIZATION BACKGROUND REQ FORM (Rev. November 2015)
Page 2 of 2
Page of 4