Tennessen Warning
The information you supply on this volunteer application will be used to assess your qualications for the City of Golden Valley’s Volun-
teer Program. You are not legally required to provide the information, but we will not be able to consider your application without it. The
information is requested to distinguish you from other applicants, to identify you in our volunteer les, to match you with an appropriate
volunteer opportunity, and to contact you for volunteer interviews.
The following information on this application will be considered private data on individuals pursuant to the Minnesota Government Data
Practices Act: your name, birth date, home address, home phone number, and driver’s license number. If you are considered eligible for a
volunteer vacancy, your name will become public data. If you are placed as a volunteer with the City of Golden Valley, all information you
supply on this application will become public except your home street address and home phone number.
Acknowledgements & Waivier
I am interested in volunteering my services to the City of Golden Valley (the “City”). If I do volunteer, I understand I will not be an employ-
ee of the City and am not guaranteed future employment. I certify that all the information I have provided on this application is correct.
I give permission to the City to contact any references I have provided and to conduct a criminal history and felony background check.
I further authorize the Minnesota Bureau of Criminal Apprehension to disclose all criminal history record information to the City for the
purpose of my volunteering with the City. This authorization expires on year from the date of my signature.
I know and understand that my participation in the Program is voluntary and I assume all risks and hazards incidental to me in volunteer-
ing my services, including those arising from my participation in activities or transportation to or from those activities. I hereby irrevo-
cably waive any and all claims against the City or any of its ocials, employees, or agents for any bodily injury (including death), loss, or
property damage incurred by me as a result of my participation in the Program.
I understand that City sta may take video or photos of City-sponsored activities. By signing this application, I waive any objection to
the City using my image in its promotional materials. If I wish to object to the use of my image, then I will make my request known to the
Parks and Recreation Department in writing.
Signature Date
Parent/guardian signature Date
Return application to:
Golden Valley Parks & Recreation
316 Brookview Parkway
Golden Valley, MN 55427
or
parksandrec@goldenvalleymn.gov
763-512-2345
Police Department Use Only
Criminal History Search MINCIS/NCIC
q No criminal history ____________ Clear
q Criminal history Disclosed to __________ on ___________.
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www.goldenvalleymn.gov/community/volunteers
