PERSON TO NOTIFY IN CASE OF EMERGENCY:
NAME:__________________________________________________________________________
ADDRESS:______________________________________________________________________
TELEPHONE:____________________________________________________________________
PAST EMPLOYMENT: LIST LAST THREE EMPLOYERS:
NAME ADDRESS TELEPHONE
1._______________________________________________________________________________
2._______________________________________________________________________________
3._______________________________________________________________________________
LIST THREE PERSONAL REFERENCES:
NAME ADDRESS TELEPHONE
1._______________________________________________________________________________
2._______________________________________________________________________________
3._______________________________________________________________________________
Have you ever been convicted of a misdemeanor or felony? Yes_____ No_______
If yes, please list the date of conviction and nature of the offense __________________________
______________________________________________________________________________
THIS IS A VOLUNTEER POSITION AND NOT TO BE CONSIDERED AS AN APPLICATION FOR
EMPLOYMENT, OR CONSIDERED AS EMPLOYMENT WITH THE COUNTY OF FRESNO.
_______________________________________________ __________________
Volunteer Signature Date
C:\Users\chawks\Desktop\VolApp.doc
Revised 7/06