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City of Gilroy

Volunteer Application



First Name:
Last Name:
Address:
City: State: Zip:
Home Phone: Cell Phone:
Work Phone: Email:
Fax:
Driver's License #: Expiration Date: Class:
CPR/FIRST AID CERTIFICATION
Special training/licenses, professional registration and skills:
Fluent Languages (Other than English):
Language:
Language:
Do you have transportation to and from your volunteer assignment?
Where did you hear about the Volunteer Program?
Which of the following types of work are you willing to accept? (Check all that apply.)
Days/Times not available:
WORK/VOLUNTEER EXPERIENCE
Date:
Organization:
Supervisor Name/Phone #:
Responsibilities:


Date:
Organization:
Supervisor Name/Phone #:
Responsibilities:

Have you ever been convicted of a felony, misdemeanor, plead nolo contendree OR been on parole or probation? If yes, list all convictions since your 18th birthday. For each conviction you must list the date, code section, and final disposition on your record. (A "Yes" answer will not automatically disqualify you from appointment.)
Date, code section, final disposition of felony conviction:
SKILLS OR AREAS OF INTEREST
Check the appropriate skills or areas of interest you have.
Other:
DEPARTMENT AND PROGRAMS
Check the appropriate area in which you want to volunteer.

The City of Gilroy is an equal opportunity, affirmative action employer.

If you require accommodations for disability which is qualified under the Americans with Disabilities Act, please inform the City of Gilroy Volunteer Service Program Coordinator what accommodation is necessary.

Depending on the nature of activity, fingerprinting and/or background check may be required. Applications will be on file for one year.


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