COUNTY OF FRESNO
PUBLIC WORKS & PLANNING PARKS
2220 TULARE ST., SUITE 600
FRESNO, CALIFORNIA 93721
(559) 600-3004
PARKS VOLUNTEER CARETAKER APPLICATION
DATE:___________________________
NAME: Mr./ Ms.____________________________________________________________
SOCIAL SECURITY #:___________________________
DRIVER’S LICENSE #:___________________________ STATE:___________________________
MAILING ADDRESS:________________________________________________________________
TELEPHONE:______________________
REQUESTED PARK LOCATION:_____________________________________________________
SIZE OF VACATION TRAILER/MOTOR HOME_____________________
SELF-CONTAINED: YES_____ NO_____ YEAR MADE:_______________________
NAMES OF ALL PEOPLE WHO WOULD BE LIVING WITH YOU:
1.___________________________________________________ AGE:_______________________
2.___________________________________________________ AGE:_______________________
3.___________________________________________________ AGE:_______________________
4.___________________________________________________ AGE:_______________________
PETS: ___________________________________________________________________________
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