Form Center

2. 
3. The City of Anacortes values volunteers. Volunteers enable us to utilize the extraordinary reserve of knowledge, talent, and skill possessed by members of our community and to capitalize on these abilities to augment City services. We seek residents interested in local government and provide an opportunity to perform work of value to the community. The volunteer application is designed to give applicants an opportunity to share their background, experience, interests and skills, enabling the City to make the best possible volunteer placement.
5. Contact Information
7. First Name*
8. Last Name*
10. Address*
12. City*
13. State*
14. Zip Code*
16. Phone Number*
17. Email Adress*
19. Are you over the age of 18?*

    1. Yes
    2. No
20. If no, please give date of birth
22. Have you ever volunteered for the library before?*

    1. Yes
    2. No
23. If yes, give volunteer date(s)
25. Are you currently certified in CPR? *

    1. Yes
    2. No
26. If yes, date certified
28. Availabilty
30. During which days are you available for volunteer assignments? *

    1. Weekday Mornings
    2. Weekday Afternoons
    3. Weekday Evenings

    1. Weekend Mornings
    2. Weekend Afternoons
    3. Weekend Evenings
31. What day of the Week?*

    1. Monday
    2. Tuesday
    3. Wednesday
    4. Thursday

    1. Friday
    2. Saturday
    3. Sunday
33. Volunteer Duration*

    1. Long-term

    1. Short-term

    1. Special Project

    1. Not sure
35. Special Skills or Qualifications
37. Summarize special skills and qualifications you have acquired from employment, previous volunteer work, or through other activities. *
39. Previous Volunteer Experience
41. Summarize your previous volunteer experience. *
43. Criminal Convictions
45. Have you been convicted of a felony or plead guilty or no contest to a felony or misdemeanor other than minor traffic offenses within the past three (3) years?*

    1. YES

    1. NO
47. If yes, please complete the following (a conviction record will not necessarily be a bar to employment)
49. Conviction
50. Location
51. Date
53. Medical Conditions
55. Do You Have Any Medical Conditions Physical or Emotional That Should Be Taken Into Consideration in Arranging Volunteer Assignments?*

    1. Yes
    2. No
56. If yes, please explain:
58. References (Do Not List Relatives)
60. Name*
61. Phone Number:*
63. Name
64. Phone Number:
66. Person to Notify in Case of Emergency
68. Name and relation*
69. Home Phone*
71. Work phone*
72. Email address*
74. Agreement and Signature
76. To the best of my knowledge, the information herein is true and complete and I understand that falsification of this application is grounds for dismissal as a volunteer. I give permission for an authorized representative of the City to contact any and all references I have given on my application, inquire of individuals about my ability to perform all aspects of the volunteer position for which I am being considered and to conduct a state patrol criminal background check in accordance with RCW 43.43.830-839. I furthermore release the City of Anacortes and those individuals/institutions that provide information from any liability that may arise from the provision of this information.
78. As a volunteer for the City of Anacortes, I am fully aware that the work associated with being a City Volunteer involves certain risks of physical injury or death. Being fully informed as to these risks and in consideration of my being allowed to participate in the City’s Volunteer Program, I hereby assume all risk of injury, damage and harm to myself arising from such activities or use of City facilities. I also hereby individually and on behalf of my heirs, executors and assignees, release and hold harmless the City of Anacortes, its officials, employees and agents and waive any right of recovery that I might have to bring a claim or a lawsuit against them for any personal injury, death or other consequences occurring to me arising out of my volunteer activities.
80. By signing below you agree to the terms above.
82. Full Name*
83. Parent or Guardian’s Signature if Under 18*
85. Date*
87. Notice to Volunteers
89. Volunteers are not considered to be City of Anacortes employees. Injury Compensation is provided through the Department of Labor & Industries. Volunteer service is considered to be creditable work experience. The data furnished on this form is furnished voluntarily and will be used to contact, interview and place volunteers.
91. Thank you for completing this application form and for your interest in volunteering with the City of Anacortes.
Leave This Blank:


93. 1. Receive an email copy of this form.
94. Email address

    This field is not part of the form submission.

95. Submit

* indicates a required field