Fillable ST. JOHNS COUNTY APPLICATION FOR VOLUNTEER SERVICE (St. Johns County Florida Government)

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ST. JOHNS COUNTY APPLICATION FOR VOLUNTEER SERVICE (St. Johns County Florida Government)

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  • 8 check-boxes
  • 61 other fields

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File type: PDF

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Parental Permission:
If
you are under the age of 18, a parent/legal guardian must sign the following permission:
I
parent/legal guardian grant permission for
to volunteer at St.Johns County.
Parent/Legal Guardian Signature:
Date:,
ST. JOHNS COUNTY
APPLICATION FOR VOLUNTEER SERVICE
Personnel Services Department
500 San Sebastian View
St Augustine, FL 32084
(904) 209-0635
A Drug Free Workplace and an Equal Opportunity Employer
Name: Last, First, Middle
Home Phone Cell Phone Email Address
Mailing Address: Street
City State
Zip
Department/Type of Volunteer Work Interested in Performing
Have you had any change of name in the past or used an assumed name?
please list the names and timeframe the names were used.
If
you answered yes to this question
Revised 4.30.2012/lmr
1
Education
(highest level completed;
□
Elementary
□
G raduate
□
High school
□
Technical
Volunteer Experience
Employer
Work Dates (From/To)
Work Performed
Street Address
City/ State
Zip
Immediate Supervisor
Employer
Work Dates (From/To)
Work Performed
Street Address
City/ State
Immediate Supervisor
Extra-curricular activities and honors received:
Skills, training or apprenticeships:
Character References:
Name
Phone#
Address
Relationship
1.
2.
3.
In Case of Emergency Please Notify:
Name
Relationship
Home Phone
Cell Phone
Address
City/State
Zip
St. Johns County is a drug free workplace and an equal employment opportunity employer and considers
applications for all volunteer positions without regard to race, color, age, sex, religion, national origin,
disability or genetics.
Revised 4.30.2012/lmr
2
□
Professional Training
□
Other.
_
□College
□
Some College
St. Johns County Volunteer Expectations
As a St.Johns County Volunteer:
1.
I shall hold absolutely confidential all information that I may obtain directly or indirectly while serving as a
St. Johns County volunteer.
2.
I shall read and comply with the policies set forth in the Administrative Code.
3.
I
will
donate my services to St. Johns County without contemplation of compensation or future
employment and give my service for humanitarian and charitable purposes.
4.
I shall not sell or attempt to sell goods or services, request contributions or solicit persons to sign or
distribute political petitions on County premises.
5.
I
will
be punctual and conscientious, conduct myself with dignity, courtesy and consideration of others, and
will endeavor to maintain a professional appearance and deliver quality service.
6.
I
will
attempt to resolve any problems related to my volunteer activities with my supervisor and, if
unsuccessful, attempt to resolve any such problems with another member of management.
7.
I
will
uphold the professional conduct and standards of St. Johns County at all times while interacting with
patrons/customers, other County staff and volunteers.
8.
I understand that St. Johns County may release me as a volunteer at anytime.
9.
I understand that St. Johns County assumes no responsibility for any contact, visits or services provided by
me that are beyond the scope of responsibilities defined by my specific work assignment.
10.
I shall participate in all required training.
I have read and understand the Volunteer Expectations as stated above and agree to adhere to them while
serving as a St. Johns County volunteer.
Signature
Date
Printed Name
Parent/Guardian Signature if under Age 18
Date
Printed Name
Revised 4.30.2012/lmr
4
Applicants Statement
I understand that
all
information provided to St. Johns County
will
become a matter of public record and
will
be
open to inspection as required by Florida Statute.
I certify that the foregoing answers are true and correct to the best of my knowledge. I authorize the investigation
of
all
statements contained in this application and hereby give St. Johns County permission to contact schools,
pervious employers, references, and others, and hereby release the organization from any liability as a result of such
contact. I understand that any false or misleading information or omissions of facts requested in this application
may remove me from further consideration for volunteer service.
I understand that my volunteer service with the organization is for no specific length of time but is based on the
needs of the organization and my willingness to devote my time and skills to support it.
The contents of the volunteer and related personnel policies as well as other organization policies and practices are
subject to change. It is my responsibility to read, understand and follow such policies and to stay abreast of
all
changes.
St. Johns County requires
all
volunteer applicants to undergo a criminal background screening and Florida driver
license verification prior to working in our organization and my signature authorizes such screenings. I also
authorize St. Johns County to review, and make decisions based on any content found on any and
all
Internet and
social media sites.
Signature
Date
Revised 4.30.2012/hnr
3
General Release and Waiver of Liability in Favor
of St. Johns County Volunteer
The undersigned acknowledges that he/she shall perform volunteer services for St. Johns County, Florida, on an as
needed basis in association with department beginning
_
(date)
The undersigned further acknowledges, accepts, and agrees to as fact, that in his/her capacity as a volunteer
beginning on the above-noted date, in association with the above-noted department, the undersigned releases,
acquits, abandons, waives, and forever discharges St. Johns County, the County's officials, emp,loyees, or staff, and
other St. Johns County volunteers from any, and all, claims (including, but not limited to, tort-based, contractual,
equitable, injunctive, and/or ;dministrative), losses (including but not limited to property, (personal and/or real),
and bodily injury), costs (including attorneys' fees), suits, administrative actions, arbitration, or mediation, that are in
any way, form, or fashion associated with the above-referenced volunteer services.
The undersigned enters into this Waiver and Release free of any duress, or any other illegal form of enticement.
If
any word, phrase, sentence, part, subsection, section, or other portion of this Waiver and Release, or any
application thereof, to any person or circumstance is declared void, unconstitutional, or invalid for any reason, then
such word, phrase, sentence, part, subsection, or other portion, or the prescribed application thereof, shall be
severable, and the remaining portion of this Waiver and Release, and all applications thereof, not having been
declared, void, unconstitutional, or invalid, shall remain in
full
force, and effect.
This Waiver and Release shall be construed according to the laws of the State of Florida. Venue for any legal or
administrative action arising under this Waiver and Release shall be in St. Johns County, Florida (for State or
administrative actions), and Jacksonville (for Federal actions).
This Waiver and Release shall be effective as of
20 .
ST. JOHNS COUNTY
BY:,
_
Department Representative
WITNESS AS TO COUNTY
BY:
_
WITNESS AS TO COUNTY
BY:
_
BY:.
_
Volunteer Signature
WITNESS AS TO VOLUNTEER
BY:
_
Revised 4.30.2012/lmr
6
Policy and Acknowledgement Statement
My signature represents that I have been provided the appropriate training to review the Administrative Code
(policy manual) which is located on the Intranet and I have read and understand the content of the Personnel
section of the Administrative Code. •I acknowledge that I am responsible for reviewing this document from time to
time as all updates/ changes are posted on this site and paper copies are not available. Further, I shall follow all
policies and established business practices of the department to which I am assigned while ,serving as an active
volunteer.
Signature
Printed Name
Date
Revised 4.30.2012/lmi:
7
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ST. JOHNS COUNTY APPLICATION FOR VOLUNTEER SERVICE (St. Johns County Florida Government)

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Completed 19 April 2021

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