Fillable City of Stayton Volunteer Application (City of Stayton)

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City of Stayton Volunteer Application (City of Stayton)

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The City of Stayton Volunteer Application (City of Stayton) form is 1 page long and contains:

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  • 6 check-boxes
  • 9 other fields

Country of origin: US
File type: PDF

U.S.A. forms for City of Stayton

BROWSE CITY OF STAYTON (OR) FORMS

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City of Stayton
Volunteer Application
NAME:
ADDRESS:
YES NO
EMAIL:
PHONE:
IS THIS COURT ORDERED COMMUNITY SERVICE?
Volunteer Work Desired:
Landscaping / Parks Maintenance
Clerical
Assist at Community Events
Special Projects (please name):
Library
Swimming Pool
EXPECTATIONS – If you have a particular interest or program you would prefer to work with please list it
below:
AVAILABILITY – What days of the week/hours of the day will you be available for volunteer work?
COMMUNITY SERVICE ONLY – Please list the name and contact information for Jurisdictional Authority
mandating the work (i.e. Probation Officer, Parole Officer, Judge, etc.):
City of Stayton
362 North Third Avenue
Stayton, Oregon 97383
(503) 769-3425
PERSONAL HISTORY INQUIRY AUTHORIZATION, RELEASE AND WAIVER
To facilitate the City of Stayton’s assessment of my fitness to serve in the position of ,
I hereby authorize the City of Stayton, its officers, agents, assigns, and employees to contact previous
employers and other sources of information and request, read, review or photocopy any and all
information the City deems necessary to lawfully investigate my residential, achievement, performance,
attendance, disciplinary, employment history, driving record and criminal history information.
I hereby exonerate, release and discharge any person, school, employer, organization or entity, and its
officers, agents and employees from any liability or damages that may result from furnishing the
information requested to the City of Stayton, including liability or damage pursuant to any state or
federal laws.
I further release the City of Stayton, its officers, agents and employees, from any such liability that may
directly or indirectly result from the use, disclosure, or release of such information. I specifically and
permanently waive any rights I may have to review or inspect any and all of the information developed
in this investigation.
A photocopy or FAX copy of this release form will be valid, as an original thereof, even though the said
photocopy or FAX copy does not contain an original writing of my signature.
Certification: I certify that I have read this authorization form, understand its meaning and purpose,
and have received a copy of it. I also understand that I may revoke this authorization
at any time by delivering to you or your organization, in writing, such revocation.
Signature of Parent (if under 18)
Signature of Applicant
Date
Printed Name of Applicant
Date of Birth
Driver’s License
Last 4 digits of Social Security Number
State of Oregon, )
)
County of )
Signed or attested before me on
by
Date
Name of Applicant
Signature of Notary Public
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City of Stayton Volunteer Application (City of Stayton)

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Completed 1 March 2021

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