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Application for Volunteer Service
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Date of Application
Date of Application
Are you Hispanic or Latino?
Are you a Veteran?
Race (select one or more)
Middle Eastern or North African
American Indian/Alaska Native
Native Hawaiian/Pacific Islander
Prefer not to respond
-- Select One --
Please indicate if you are a member of an organization applying to volunteer as a group.
Beneficiary of FREE supplemental Volunteer Insurance
Check all that interest you
Arts & Crafts Instructor
Dining Room Aide
Dance & Activities Planner
Senior Programs Representative
If you elect "other," please specify
What is your education background?
Why do you wish to volunteer?
How did you hear about us?
What is your T-shirt size?
Will you require any special accommodations as a volunteer?
If "yes," please explain
Have you been convicted of (or plea bargained to) any violations of law, including felony charges?
Do you have any pending charges or cases open in which a decision has not been made yet?
If yes to either question above, please provide description of the offense, date of charge, date of conviction, pending charges, County, City or State of convictions
Please note volunteer placement may be subject to the results of a criminal background check or other screening
Check the best schedule for your needs
Check your availability for volunteer service
Electronic Signature Agreement
I certify that the above information is correct and complete to the best of my knowledge, without consequential omission of any kind. I authorize the Volunteer Network to release information requested regarding my service, character, and qualifications. I understand that the Volunteer Network may conduct a criminal background check as part of the screening process if my volunteer service involves either working with children, frail seniors, or concerns sensitive information. I understand that I'm not an employee of the Volunteer Network or the City of Las Cruces and agree to serve without compensation or employee benefits. Specifically, I recognize that I will not be entitled to Worker's Compensation should I become injured during my volunteer service. Specifically, I acknowledge that I will not be entitled to Worker's Compensation should I become injured during my volunteer service. I recognize that volunteer work is not without risks, and I agree to help minimize those risks by exercising reasonable judgment and due care for my safety, which may involve not performing a task that goes beyond the risks I wish to accept. I further agree that if I use my personal automobile to drive to and from my Volunteer Station or during my service, I will keep in effect automobile liability insurance equal to or greater than the minimum required by the state of New Mexico and will ensure that my driver's license is kept current and has not expired. I acknowledge that by completing this application, The Network is not obligated to offer me a volunteer position. I also understand that the Volunteer Network/City of Las Cruces may use my story, photos, and videos of me and my volunteer service in upcoming publicity and marketing materials. I understand the Volunteer Network will use an email service to maintain contact with me regarding future events or service opportunities and that I may opt-out of this service at any time.
Electronic Signature of Parent
Sign here if volunteer is under 18 years old
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