Form 08.180 Page 1 of 2
Volunteer Service Application
Directions: Please complete all pages, even if resume is attached, and forward a copy to Human Resources.
Today’s Date:
Name (Last) (First) (Middle)
Present Address:
Day Phone with Area Code:
Evening Phone with Area Code:
Are you eligible to work in the U.S. for the duration of the Volunteer assignment?
(U.S. Citizen, Permanent Resident, or Appropriate Visa):
Yes No
Are you at least 18 years old? Yes No*
* If the answer is NO, please see the Legal Guardian signature needed below.
Have you ever volunteered for UNCW? Yes No
If yes, indicate dates, department and contact name:
Emergency Contact Name:
Relationship to You:
Phone Number(s):
Name Relationship E-Mail Address Phone Number
VOLUNTEER SERVICE INFORMATION (to be completed by Department)
UNCW Department:
Department Contact Name & Phone Number:
Start Date: End Date: Est. Hours Per Week:
Does this volunteer role involve unsupervised contact with students or minors? Yes* No
*If the answer is YES, a criminal background check must be conducted prior to commencement of volunteer service.
Clear Form
Form 08.180 Page 2 of 2
Volunteer Service Application
Describe Volunteer Role/Activity:
Department Sponsor (Print/sign name and title) Date
Department Head/Chair (Print name) Date
1. I understand and agree that my volunteer service is in no way an offer of or employment by UNC Wilmington and
that I shall not receive, nor be entitled to receive, any compensation, reimbursement or remuneration for my
participation in my volunteer service. I further agree to release UNC Wilmington from any and all claims to
compensation, reimbursement or remuneration related to my volunteer service. I also understand and agree that at
no time will I be considered or deemed to be an agent or employee of UNC Wilmington.
2. I understand that as a University Volunteer, UNC Wilmington does not provide me with accident or medical
insurance and is therefore not responsible for any accident or medical expenses incurred by me. Further I
understand that I am not entitled to employee benefits as a result of my University Volunteer affiliation.
3. I agree to act appropriately and in a professional, courteous manner during my volunteer service. I understand and
agree that UNC Wilmington may terminate my volunteer service at any time, with or without cause.
4. I understand that during my volunteer service, I may have access to, or my observe, certain information that is
proprietary to UNC Wilmington and I hereby agree not to disclose, discuss or reveal any such information to
parties outside of UNC Wilmington and to keep any University records or files confidential.
5. Volunteers enrolled in services to state agencies are recognized to be covered under Articles 31 and 31A of
Chapter 143 of the North Carolina General Statutes, governing Tort Claims against State Departments and
Agencies and the Defense of State Employees Act. Volunteers enrolled in such services to state agencies,
however, are not entitled to benefits under Chapter 97 of the North Carolina General Statues, The Worker
Compensation Act. A volunteer shall remain fully responsible for acts and omissions outside the scope of his or
her volunteer services.
6. I have read and understood this Volunteer Services Application and Statement of Agreement & Release and I do
voluntarily sign said document of my own accord and as a condition of being allowed to participate with my
volunteer service. I certify that all statements in this application are true. I also agree that if I am accepted as a
volunteer, I will abide by all applicable policies and regulations of UNC Wilmington.
Volunteer Signature Date
Legal Guardian Signature (if Volunteer is under 18 years of age) Date
Print Name if Legal Guardian: