Name:
Mailing Address:
City: State: ZIP:
Home Phone: Cell Phone:
Email Address:
Current employee at Cuesta? Yes (if yes, what department _______________________ No
Current student at Cuesta?
Yes
No
If you checked “No” to the above two questions, please fill out the following information for a parking permit:
Vehicle License: Vehicle Make/Model:
Vehicle Color: Vehicle Year: Driver’s License #:
VOLUNTEER WORK REQUEST 2019-2020
Definition of a volunteer: “Someone acting without legal obligation; a participant in something who is not legally bound
to participate and does not expect to be paid.”
Directions: Volunteers complete Part I. Fingerprint clearance and TB work clearance is required of all volunteers.
Human Resources will provide paperwork. Board Policies are available on the web.
site: http://www.cuesta.edu/about/depts/humanresources/new_employee_forms/Short-term_Student.html
No volunteer may begin college volunteer activities until this form is completed and approval has been given by the Human
Resources Office.
PART I
COMPLETED BY VOLUNTEER
PART III COMPLETED BY HUMAN RESOURCES
Legal Name: Banner ID:
Fingerprints TB Test Social Security Card Driver’s License Employment Data Form
The volunteer named on this form has completed and submitted all of the required paperwork.
Human Resources Signature: Date:
PART IV COMPLETED BY PUBLIC SAFETY
Volunteer parking permits may be issued to volunteers of the college. Approval is required by Public Safety.
Department:
Time Period Valid Through:
Permit #
NO CHARGE
Public Safety Approval: Date:
PART II
COMPLETED BY REQUESTING DEPARTMENT
Requesting Department:
Volunteer services to assist with:
Earliest Preferred Start Date: End Date:
Supervisor (Print name):
Date:
Supervisor Signature:
Approving Manager (Print name):
Date:
Approving Manager’s Signature:
I certify that all the information I have provided above is true and complete to the best of my knowledge. I understand
that I will not be paid for this professional volunteer assignment.
Volunteer (Print name):
Date:
Volunteer’s Signature:
I have read Board Policies 3410, 3430, 3720 (found on the Human Resources
page link above)
Units:
Birthdate:
Parent/Guardian Signature (if volunteer is under 18):
Date:
