Fillable Fseprd578348 OMB Number 0596-0080 Optional Form 301

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Fseprd578348 OMB Number 0596-0080 Optional Form 301

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OMB 0596-0080
VOLUNTEER SERVICE APPLICATION—NATURAL & CULTURAL RESOURCES
The volunteer application helps public lands officials and potential volunteers determine if there are volunteer opportunities that are a good match for the skills
and interests identified. All volunteers are required to complete a volunteer agreement once they have identified and committed to a specific volunteer activity.
Mark in the appropriate boxes and print or type all responses.
1.
Name (Last, First, Middle)
2.
Age
3.
Telephone Number
( ) -
4.
Email Address
5.
Street Address, Apt. #
6.
City, State, and Zip Code
7.
Which general categories are you most interested in volunteering? Check all that apply.
Archaeology
Botany
Campground/Site host
Campground maintenance
Construction maintenance
Computers
Conservation education
Fish/Wildlife
Historical/Preservation
Pest/Disease control
Minerals/Geology
Natural resources planning
Office/Clerical
Range/Livestock
Research/Librarian
Soil/Watershed
Timber/Fire prevention
Trail maintenance
Tour guide/Interpretation
Visitor information
Other (Please specify)
8. What qualifications, skills, or experiences do you have that you would like to use as a volunteer? Check all that apply.
Backpacking/Camping
Biology
Boat operation
Carpentry
Clerical/Office machines
Computer programming
Drafting/Graphics
Driver’s license
First aid certificate
Hand/Power tools
Heavy equipment o
peration
Horses – care/ riding
Landscaping/Reforestation
Land s
urveying
Livestock/Ranching
Map reading or GIS/GPS
Mountaineering
Photography
Public speaking
Research/Librarian
Sign language
Supervision
Other trade skills (Please specify)
Teaching
Working with people
Writing/Editing
Other (Please specify)
9. If you have a specific volunteer interest, please identify and describe your qualifications, skills, experiences, or education that
may apply.
10. Are you a United States Citizen? Yes No (If no, additional information may be required)
11. a. Have you volunteered before? Yes No
b. If yes, please list the organization where you volunteered with a contact name and phone # or email address, and briefly
describe what you did.
12. Would you like to supervise other volunteers? Yes No
13. What are some of your objectives for volunteering? (Optional)
Volunteer Service Application OF301 USDA-USDI-DOC-DOD
OMB 0596-0080
14.
Please list any physical limitations that may impact your volunteer activities.
15. a. Which months are you available to volunteer? Check all that apply.
January
July
February
August
March
September
April
October
May
November
June
December
15b. How many hours per week would you be available for volunteer work? Hours
15c. Which days are you available to volunteer? Check all that apply.
Monday Tuesday Wednesday Thursday Friday Saturday Sunday
16. Specify states or locations where you would like to volunteer.
17. Specify your lodging needs:
I will furnish my own lodging (such as tent; camper; own, relative’s, or friend’s place)
I will require assistance in finding lodging
18. If a volunteer assignment is not available at the location specified in box #16, do you want your application forwarded to
another location or Federal agency seeking volunteers with your background or interests?
Yes No (Please specify)
19. How did you hear about this volunteer opportunity? Check all that apply.
Volunteer.gov
Brochure
Other internet or website
Volunteer fair or event
Advertisement
Other (Specify)
Word of mouth (friend, colleague, family member)
Public Burden Statement
According to the Paperwork Reduction Act of 1995, an agency may not conduct or sponsor, and a person is not required to respond to a collection of information
unless it displays a valid OMB control number. The valid OMB control number for this information collection is 0596-0080. The time required to complete this
information collection is estimated to average 15 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering
and maintaining the data needed, and completing and reviewing the collection of information. USDA, DOI, DOC and DOD prohibit discrimination in all programs
and activities on the basis of race, color, national origin, gender, religion, age, disability, political beliefs, sexual orientation, and marital or family status. Not all
prohibited bases apply to all programs.
Notice to Volunteer
Volunteers are not considered Federal employees for any purposes other than tort claims and injury compensation. Volunteer service is not creditable for leave
accrual or any other benefit. However, volunteer service is creditable work experience. By signing this application the volunteer(s) understand(s) s/he may be
subject to a reference check, background check, and/or criminal history inquiry.
Privacy Act Statement
Collection and use is covered by Privacy Act System of Records OPM/GOVT-1 and USDA/OP-1, and is consistent with the provisions of 5 USC 552a (Privacy Act of
1974), which authorizes acceptance of the information requested on this form. The data will be used to maintain official records of volunteers of the USDA and
USDI for the purposes of tort claims and injury compensation. Furnishing this data is voluntary, however if this form is incomplete, enrollment in the program
cannot proceed.
20. Signature
21. Date
Volunteer Service Application OF301 USDA-USDI-DOC-DOD
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Completed 26 July 2020

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