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Martha Blakeney Hodges Special Collections and University Archives

Volunteer Worker Application

* = Required Fields

General Information

Today's Date: 11/1/2014

Name:*

Email:*

Address:*

Telephone:*

In case of emergency notify:*

Relationship:*

Home Phone:*

Work Phone:

Cell Phone:

Citizenship: *

Are you 18 years of age or older?: *

*If no parent must sign at the bottom of the form.

Are you Currently employed at UNCG: *


If yes, Where? How many hours a week?:

Work Experience

Place of Employment:

Position/Responsibilities:

Dates of Employment:

Supervisor:

Supervisor Phone Number:

Education

High School:* Grade completed:

College - Degree:

Graduate School - Degree:

List any physical limitations you have that should be considered when matching you with volunteer tasks:

Please write a brief description as to why you want to volunteer at the library, including any specials skills or interests and any previous volunteer experience.*

Are you seeking to fulfill volunteer hours as a requirement? If so, explain (school, service club, court ordered, etc.):

Would you be willing to be paired with another volunteer with skills that are on a different level from your own?

Have you ever been convicted of any offense against the law, including minor traffic violations? If yes, please explain the nature of the conviction and the final disposition of the case.

I certify that the information on this application is complete and correct to the best of my knowledge. I herby authorize an investigation of all statements made in this application and I herby release from liability all persons, companies or corporations supplying any information concerning me.

I understand that pursuant to former Governor Hunt’s Executive Order No. 48, Volunteers who are acting within the scope of their authorized activities on behalf of the University are covered by the North Carolina Tort Claims Act and the Defense of State of Employees Act. This means that the State accepts legal responsibility for the Volunteer’s actions and, at the discretion of the North Carolina Attorney General, may agree to defend and indemnify the volunteer in the same manner as if the volunteer were an employee of the State of North Carolina.

I understand that volunteers are hired based on the interview, reference checks and the needs at the time for the position(s) I am interested in and the times I am available.

Signature:*

Signature of parent/guardian if applicable: