Volunteer Application Broward County

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VOLUNTEER APPLICATION
VOLUNTEER APPLICANT INFORMATION
Name:
Date of Birth:
Current Address:
City:
State:
Zip Code:
Phone 1:
Phone 2:
Email:
AREA OF INTEREST
Language spoken other than English:_____________________________________
Preferred Library Location: _______________________
Hours and days available to Volunteer:_______________________________________________
Interests: Adults___ Teens___ Other___
EMERGENCY CONTACT INFORMATION
Name:
Phone Number:
Relationship:
CRIMINAL BACKGROUND CHECK
TH
SINCE YOUR 18
BIRTHDAY, HAVE YOU BEEN CONVICTED OF ANY VIOLATION OF THE LAW, OTHER THAN MINOR TRAFFIC
OFFENSES, OR PLED NOLO CONTENDERE (NO CONTEST) TO CRIMINAL CHARGES, EVEN IF ADJUDICATION WAS WITHHELD?
Yes____ No ____ If Yes, Please Describe:
Name of Offense _________________________________________________
MISDEMEANOR
FELONY (Check One)
Name of and Location of Court ________________________________________________________________________________________
Disposition of Case ____________________________________________________________________ Date: _______________________
N ote: One conviction w ill not autom atically keep you from volunteering at a Brow ard County Library location. M ore than one conviction (of
any kind) or a conviction for other than driving under the influence (DUI), a traffic violation, unlaw ful assem bly, or shoplifting (only if you
w ere a m inor) w ill disqualify you.
SIGNATURES
The above information is accurate and correct to the best of my knowledge.
Signature of Applicant:_______________________________________________________________
Date:__________________________
*****FOR DIVISION USE ONLY*****
Work Location: ________________________ Site Coordinator: ________________________________Date: __________
Check all that Apply:
Criminal Background Information Form and Photo ID Attached _____ Yes _____No
Parental Consent Form Attached (if applicable) ______ Yes _____No
Community Service Volunteer Form (if applicable) ___Yes _____No
Was this applicant approved for volunteer work? ____Yes ____No
A Service of the Broward County Board of County Commissioners

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