Adult Volunteer Application

Adult Volunteer Application
Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState

Zip Code
Phone Number*
Add your best contact to reach you.
E-mail Address*
example@example.com
Date of Birth*

MonthDayYear
(Date of birth is being requested for the purpose of conducting a criminal background check and will be used solely for these purposes)
Do you possess a valid Florida Driver's License?*

YesNo
Driver License*
Expiration Date*

MonthDayYear

Educational Background
Education Level*

High School Diploma /GEDCollege
College*
Degree*

Work Experience
Employer Name
Supervisor Name

First NameLast Name
Work Address

Street Address

Street Address Line 2

CityState

Zip Code

Additional Legal Information
Is there anything in your past, which might disqualify you from functioning as a volunteer for the City of Coral Springs?

YesNo
If yes, please explain...
Have you used any illegal controlled substance in the last year?

YesNo
If yes, please explain...
Have you ever been arrested?

YesNo
If yes, please explain...

Reference

List personal reference, other than family.
Reference Name*

First NameLast Name
Reference Address*

Street Address

Street Address Line 2

CityState

Zip Code

Emergency Contact
Contact Name*

First NameLast Name
Relationship to Volunteer
Phone Number*

As an applicant for a volunteer position with the City of Coral Springs, I am willing to furnish information for use in determining my qualifications. In this connection, I authorize release of any and all information that may be available concerning me, including information of a confidential or privileged nature.

I hereby release you, the City of Coral Springs and others from liability or damage which may result from furnishing the information requested.

I understand that for security reasons, a clearance check will be conducted and I may be finger printed. Further background information will be requested only if a specific volunteer assignment calls for a further security clearance. I agree to abide by all rules that apply to the Volunteer Program.

As a volunteer for the City of Coral Springs, I understand that I can be dismissed without cause and without notice, and that I am not eligible for compensation or benefits for services rendered.
By typing my name in the below space, I am electronically signing this form. My signing this electronic signature certifies the information to be true, accurate, and complete.*

First NameLast Name
Time & Date Stamp

MonthDayYear
Hour MinutesAM/PM Option
This form can be also be returned by: U.S. Mail: Volunteer Services, City of Coral Springs, 9500 West Sample Road, Coral Springs, FL 33065 Drop off at: City Hall in the Volunteer Services deparment which is located at 9500 West Sample Road, Coral Springs, FL 33065 You will need also read, sign and return the Release and Waiver. If you have any questions, please call 954-346-4430.
Should be Empty:

Adult Volunteer Application

Tell us a little bit about yourself...

Educational Background

Volunteer Experience

Work Experience

Additional Legal Information

Reference

Emergency Contact