Fill - Free fillable VOLUNTEER APPLICATION (City of Bisbee) PDF form

Personnel Department - City of Bisbee

76 Erie Street – PO Box 4601

Bisbee, Arizona 85603

Tx: (520) 432-6271 Fx: (520) 432-6069

VOLUNTEER APPLICATION

Instructions:

You may apply by mailing or delivering a completed application form to:

Drop Off: Mail:

City of Bisbee City of Bisbee

76 Erie Street PO Box 4601

Bisbee, AZ 85603 Bisbee, AZ 85603

Applications can also be emailed to personnel@bisbeeaz.com or faxed to (520) 432-6069.

Volunteer Applications which are incomplete or unsigned will not be accepted.

The city accepts and encourages the involvement of volunteers in various City departments. A volunteer is anyone who, without

compensation or expectation of compensation, performs a task at the direction of and on behalf of the City. Volunteers must be

officially accepted and enrolled by the City as provided in this policy prior to the performance of any tasks. The City accepts

the service of each volunteer at its sole discretion. Either the City or the volunteer may terminate the relationship at any time,

and for whatever reason. Volunteer in some departments or positions may require a background check.

The City of Bisbee provides an equal employment opportunity (EEO) for all persons regardless of race, color, sex age, religion,

national origin, disability, or marital status. The City of Bisbee complies with applicable state and local laws governing

nondiscrimination in all employment activities.The City of Bisbee complies with the American’s with Disabilities Act (ADA)

and will provide reasonable accommodation for qualified individuals with disabilities. Requests for reasonable accommodation

during the recruitment or hiring process must be sent to the Personnel Department.

Last Name First Name Middle Initial

Mailing Address City State Zip Code

Telephone Number Email Date Of Birth Social Security Number

Volunteer Position/Department Requested: Date of Application:

__________________________________________________________________________________________________________

How did you learn about us?

□ City website □City Employee □ Newspapter Ad □ Online Ad □ Other :

City of Bisbee

Volunteer Application

Education High School, College, University, Technical/Trade School or any other educational programs

School Name

Location: City / State

Course of Study

Years completed

Diploma / Degree

Employer: Job Title: _________________________________

Employer Address: __________________________________________________________________________________________

Telephone: ( ) May we contact this employer? □ Yes □ No

From: / to /

month year month year

Reason for Leaving: Name of Supervisor: _______________________

Description of Duties: __________________________________________________________________________________________

____________________________________________________________________________________________________________

Employer: Job Title: _________________________________

Employer Address: __________________________________________________________________________________________

Telephone: ( ) May we contact this employer? □ Yes □ No

From: / to / Total months: Hours/ week:

month year month year

Reason for Leaving: Name of Supervisor: _______________________

Description of Duties: __________________________________________________________________________________________

____________________________________________________________________________________________________________

EMPLOYMENT HISTORY: Please provide an accurate and complete description of any work which qualifies you for the

volunteer opportunity for which you are applying. Include service in the armed forces or self-employment. Start with your

present or most recent employer. If you have more jobs to list than space allows, continue on the Employment History

Continuation Sheet.

City of Bisbee

Volunteer Application

Employer: Job Title: _________________________________

Employer Address: __________________________________________________________________________________________

Telephone: ( ) May we contact this employer? □ Yes □ No

From: / to / Total months: Hours/ week:

month year month year

Reason for Leaving: Name of Supervisor: _______________________

Description of Duties: __________________________________________________________________________________________

____________________________________________________________________________________________________________

Skills/Training: Describe any specialized training, licenses, certifications, language proficiencies or other qualifications which

have not been previously listed and which you believe relate to the position for which you are applying. Be specific in your description:

____________________________________________________________________________________________________________

References: List three professional references with direct knowledge of your work experience.

Name

Phone Number

Email

Occupation

EMPLOYMENT HISTORY - CONTINUED

I hereby certify and affirm that all the information contained in this application and all supplemental attachments is true,

complete and correct. I understand that false or misleading statements or the omission of important information made on

this application or any time during the selection process may disqualify me from volunteer opportunites or subject me to

immediate dismissal if already enrolled as a volunteer.

Volunteer Signature: Date:

If volunteer is under 18,

Parent/Guardian SIGNATURE: Date:

Parent/Guardian Name PRINTED:

City of Bisbee

Volunteer Application

Employment Application Addendum

Please complete the following and return this form with your completed application for employment.

Both application and addendum must be signed.

1. Do you have any criminal convictions (not to include civil traffic violations and juvenile offenses)?

If so, give the details below, including when and where the offense occurred and the disposition

of the case. For MOST jobs, convictions will NOT automatically be grounds for disqualification

from consideration. The failure to answer truthfully will be grounds for disqualification.

Yes ______ No ______

Details:

2. Are you currently subject to any probation or parole orders or any civil orders that restrict or

regulate your conduct in any manner? If so, please explain fully.

Yes ______ No ______

Details:

I hereby certify that all statements contained herein are true to the best of my knowledge and I understand

omissions or misstatements may be cause for rejection of this application, removal of my name from an

eligibility list or discharge from the City of Bisbee, regardless of the time of discovery.

Signature: _________________________________________ Date: __________________

Name printed:

City of Bisbee

Volunteer Application

Authorization and Consent To Disclosure

Date ___________________ (Expires six months from this date unless revoked earlier.)

I understand that all information provided to the City of Bisbee is subject to verification. To assist the City of

Bisbee in processing my employment application, the undersigned applicant for employment hereby authorizes

any employer or prior employer, educational institution, law enforcement agency, consumer reporting agency,

governmental agency, or any person or organization possessing employment, educational or police record

information concerning me to release all such information to the City of Bisbee, its agents and employees.

Name:

Date of Birth: SS#:

Maiden Name:

Other Name(s) Used:

Driver’s License #: State:

I specifically authorize the City of Bisbee, through its designated representatives, to view, copy, be furnished

copies and be given details of all such employment information, educational records, police records and

financial information, specifically to include credit history information. Any copy of this authorization shall

have the same authority as the original.

Signature _________________________________________________________________________

Physical Address

City of Bisbee

Volunteer Application

Employment Application Addendum

For positions within the Police Department, Fire Department

and certain Public Works and other department positions.

In accordance with the Drug-Free Workplace Act of 1988, the City of Bisbee, as a federal grant recipient, is

required by federal law to certify to agencies from which it receives grants that it ensures a drug-free

workplace.

Accordingly, on August 17, 1990, the City of Bisbee’s “Drug Free Workplace Policy” went into effect. The policy

requires that all successful applicants for positions with the Police Department, the Fire Department, and

certain positions within the Public Works and other Departments, must pass a screening for drugs and alcohol.

Confidentiality of test results is maintained.

As a condition of hire, I understand that I will be asked to sign a pre-employment drug screening form. Failure

to do so, or a failure to pass said testing, will result in an automatic disqualification of my application for

employment as:

Position applied for:

Signature: _________________________________________ Date:

Name printed:

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Fillable VOLUNTEER APPLICATION (City of Bisbee)

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