Volunteer Application

First Name * Ex: John

Last Name * Ex: Smith

Address * Ex: 123 Main St., Newark, OH 43055

Phone Ex: 555.555.5555

Email Address * Ex: johnsmith55@gmail.com

Preferred Contact Method

Email
Phone
No Preference

Emergency Contact Name * Ex: Jane Smith

Emergency Contact Number * Please list a number for you emergency contact

Emergency Contact Relationship * How are you related to your emergency contact?

Other Information

Education Highest grade completed

Current school (if applicable)

Employment history Please list your employer, dates employed, and what were your duties?

Volunteer history Please list any volunteer experiences, if applicable

Why are you interested in volunteering?

Community service hours? Please describe the community service hours needed. Are they needed for school? work? court ordered? How many hours are required, by when?

What would you prefer to volunteer for? Are you applying for a specific volunteer position? If so, which one?

Dates and times available

Hours preferred

Preferred location

Buckeye Lake
Downtown Newark
Hebron
Johnstown (Mary E. Babcock)
Utica
West Newark (Emerson R. Miller)
Bookmobile

References

Are you 18 or older? * Applicants must be 14 years of age or older. Applicants under 18 require consent of a legal guardian.

May we do a background check? * I understand that I must submit to a background check before being assigned any volunteer responsibility at Licking County Library. Cost of processing background check is $18.27. After one hundred hours of volunteer service, you may request a reimbursement.

Must Verify Information * I certify that all statements made in my volunteer application are true and correct to the best of my knowledge. I give the Licking County Library permission to verify all information contained in this application as may be necessary.

Signature * Please type your name to acknowledge that the information provided in this form is correct?

Signed Date *

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101 West Main Street
Newark, OH 43055
740.349.5500
info@lickingcountylibrary.org