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PRCA VOLUNTEER CANDIDATE INFORMATION PART 1 PAGE 1 OF 3 PARKS, RECREATION and CULTURAL AFFAIRS (PRCA) VOLUNTEER CANDIDATE INFORMATION Thank you for your interest in seeking to become a volunteer with the City of Farmington Department of Parks, Recreation and Cultural Affairs (PRCA). It is the policy of PRCA to consider candidates for volunteer service based on qualifications for specific volunteer jobs within the divisions of the department without regard to race, color, religion, sex, national origin, age, disability, or any other legally protected status. Volunteer Candidate Information is used to determine suitable placement. Please type or complete this form in ink as neatly and clearly as possible. Answer all questions to the best of your knowledge. Candidates will be contacted for an interview and consultation on possible volunteer placement after completed application is received. To be authorized for volunteer placement and service, candidates may be required to sign a release form for an extensive background check. Candidates who are authorized for volunteer service through the background check process will be photographed and issued a photo identification badge. Some divisions within the department may require volunteers to attend orientation and/or specific training before their first scheduled day of volunteer service. Candidates 15 years and younger require a parent/guardian to serve with the child. A parent/guardian signature is required for candidates under 18 years of age. The following is a list of the divisions & events of the City of Farmington’s PRCA Department. Please indicate one or more areas of interest: Animal Shelter Farmington Clean & Beautiful Parks Operations Bonnie Dallas Senior Center Golf Course – Civitan Pools – Aquatic Center Civic Center Golf Course – Pinon Hills Pools - Brookside Event – Civic Center Sandstone Productions Meals On Wheels Pools - Lions Event – Civic Center Road Apple Rally Museums – Farmington Museum at Gateway Park Recreation Center Event – Connie Mack World Series Museums – E3 Children’s Museum & Science Center Sycamore Park Community Center Event – Museum Renaissance Faire Museums – Harvest Grove Farm & Orchards Indian Center Event – Museum Totah Festival Indian Market Museums – Riverside Nature Center How often are you available to volunteer? Once a week Once a month Daily Other please specify: What times of day are you available? MONDAY TUESDAY WEDNESDAY THURSDAY FRIDAY SATURDAY SUNDAY AM PM Are you interested in volunteering in more than one location? ___Yes ___No For special events? ___Yes ___No Are you currently a City of Farmington employee? ___Yes ___No Have you ever worked for the City of Farmington? ___Yes ___No Employment Dates (mo/yr) Are you currently employed? ___Yes ___No If Yes, Are you currently volunteering? ___Yes ___No If Yes, Are you volunteering to complete a requirement of hours? ___Yes___No If yes, please list name of organization and number of hours required PLEASE RETURN VOLUNTEER CANDIDATE INFORMATION TO: PARKS, RECREATION, AND CULTURAL AFFAIRS ADMINISTRATION OFFICE 901 FAIRGROUNDS ROAD (505) 599-1401 ---PAGE BREAK--- PRCA VOLUNTEER CANDIDATE INFORMATION PART 1 PAGE 2 OF 3 Name: DATE: Mailing Address: Number & Street City State Zip Code Street Address: If different from above Daytime Phone: Evening Phone: E-mail: Birthday(mo/day) I give permission for my name and address / E-mail to be put on a general mailing list to receive any mailings from other divisions within the PRCA Department Address: ___Yes ___No E-mail: ___Yes ___No Do you have a High School Diploma or a G.E.D.? ___Yes ___No If No, indicate highest grade completed.______ Education from an Accredited College/University: College Major Type of Degree Degree Completed? Credit Hours Yes No Language Proficiency (Other than English): Language Speak Read Write Yes No Yes No Yes No List two persons to contact in case of emergency. The second person will be called if the first person can not be reached. Name: Relationship: Daytime Phone: Evening Phone: Name: Relationship: Daytime Phone: Evening Phone: For safety considerations, do you have any medical or physical conditions that would involve special placement? ___Yes ___No If Yes, please explain: Please list employment history (agency names and your responsibilities): Please list volunteer history (agency names and your responsibilities): Please check your skills: Customer Service Telephone Etiquette Microsoft Office Typing Filing Accounting Retail Sales Please list all skills or areas of interest: ---PAGE BREAK--- PRCA VOLUNTEER CANDIDATE INFORMATION PART 1 PAGE 3 OF 3 LIABILITY WAIVER/ACKNOWLEDGEMENTS I waive any claims against the City of Farmington Department of Parks, Recreation and Cultural Affairs (PRCA), its agents, officers, employees and volunteers from any and all liability and release and hold harmless for death, personal injury, and destruction of property, loss, expense or claim for injury or damages not caused by the intentional acts of City of Farmington employees or the gross negligence of said employees arising from my participation as a volunteer. I realize that each division and event holds unique risks depending upon its nature. For example, a volunteer who works in the animal shelter will be exposed to risks of working with animals, e.g. dog behavior and risks in exercising animals, and a volunteer who works at the golf course may be exposed to risks of in-air golf balls. These risks are inherent, and they vary according to the nature of each division or event and the details of the volunteer position, and I accept these risks. I understand I would not be compensated for any of my services and that my placement as a volunteer would not result in employment with the City of Farmington. I understand that volunteer placement is conditioned upon favorable background information as determined by the City of Farmington Department of PRCA. I understand that the City of Farmington Department of PRCA is not obligated to provide me with a volunteer placement, and I am not obligated to accept the volunteer position offered. I understand that the City of Farmington Department of PRCA reserves the right to terminate my volunteer status at any time. As a volunteer I understand I may be photographed for educational, archival, and public relations purposes. CANDIDATE PARENT/GUARDIAN Volunteers who are not authorized for volunteer service through the background check process will not receive a photo identification badge. Volunteers 15 years and younger will not receive a background check or a photo ID badge until they are 16 years of age or older. COST FOR REPLACEMENT OF PHOTO IDENTIFICATION BADGE Volunteer understands that the photo identification badge must be worn whenever he/she is volunteering for the City of Farmington Department of Parks, Recreation and Cultural Affairs. Volunteer understands that if the photo identification badge is lost, the volunteer is responsible for the replacement cost of $5.00. CANDIDATE PARENT/GUARDIAN FOR OFFICIAL USE ONLY DIVISION REQUIREMENTS: The following is a checklist for volunteer coordinators Checklist Requirement Completed Received Completed Volunteer Candidate Information Form Candidate signed liability waiver/acknowledgements Candidate signed cost for replacement of photo ID badge Candidate 16 years and older completed, signed & had notarized Volunteer Candidate Release Form Coordinator completed Volunteer ID Badge Information to submit to HR with Candidate forms Forms given to HR for processing – never copy the completed Volunteer Candidate Release Form Record Date Forms given to HR for processing Background Check Completed – Record Date Completed Schedule Volunteer for Photo ID Badge at HR and Record Badge ID Number Issued Volunteer Start Date is the date printed on the Volunteer Candidate Information Form Record Volunteer Information in Volunteer Database Record Date of Volunteer Orientation – Introduction to PRCA Department Record Date of Volunteer Training for specific job position Record Date of 90 day evaluation Record Date of each yearly evaluation Record Date volunteer becomes inactive or resigns from volunteer program Volunteer Placement Facility or Special Event Job Title Direct Supervisor Volunteer Schedule ---PAGE BREAK--- PRCA VOLUNTEER CANDIDATE INFORMATION PART 2 PAGE 1 OF 2 PLEASE RETURN VOLUNTEER CANDIDATE INFORMATION TO: PARKS, RECREATION, AND CULTURAL AFFAIRS ADMINISTRATION OFFICE 901 FAIRGROUNDS ROAD (505) 599-1401 VOLUNTEER CANDIDATE RELEASE FORM The City of Farmington conducts an extensive background investigation of criminal history. A criminal conviction does not constitute an automatic bar to placement. Each case is considered individually and based on job requirements. However, failure to answer truthfully will result in disqualification for placement with the City of Farmington Department of Parks, Recreation and Cultural Affairs Volunteer Program. “Crime” as used in this section means any and all felonies, misdemeanors, and serious driving offenses. “Crime” does not include minor civil traffic offenses. If you are unsure how to answer this question, please ask for assistance. “Convicted” means that you have been found guilty by a court or jury, pleaded guilty or no contest to a crime and/or have been sentenced for a crime, whether incarcerated, placed on probation, fined, or received suspended sentence. Have you ever been convicted of a crime, regardless of whether the conviction was later set aside or expunged, in any domestic, foreign or military court? ___Yes ___No Are you pending charges, trial or other court proceedings for any crime, in any jurisdiction, at this time? ___Yes ___No If you answered yes to either or both questions, please give details including the offense(s) for which you were convicted or are currently pending charges, date of conviction, and jurisdiction (court, city, county and state), on a separate sheet of paper. If an offense has been set aside or expunged, please give date of action. CONDITIONS I fully understand that the City of Farmington, to protect its citizens, will conduct a background check of my name through law enforcement agencies and license bureaus and any or all of the following may be required before placement in any sensitive volunteer position: Background Investigation including police and court records Fingerprinting Substance Abuse Testing Motor Vehicle Check Authorization for the Release of Information and Records: I am seeking to become a volunteer with the City of Farmington Department of Parks, Recreation and Cultural Affairs (PRCA) and I hereby direct and authorize the City of Farmington Department of PRCA to conduct a thorough background check through any agencies the City of Farmington Department of PRCA deems necessary. I waive and release any and all manner of actions, causes of action, and demands of every kind, nature and description, arising from any release of criminal records and request there from, whatsoever against the State of New Mexico, City of Farmington Department of PRCA, in both law and equity, which I may have now or in the future. Age: Date of Birth: Social Security Number: Driver’s License Number and State of Issue: Address: Candidate Printed Name: Candidate Signature: Parent/Guardian Signature: (if candidate is a minor) Date: Sign and date in the presence of a Notary Public. Signature indicates understanding and acceptance of the above conditions. State of New Mexico, City of Farmington, County of San Juan Subscribed and sworn to before me this day Date Commission Expires Notary Public FOR OFFICIAL USE ONLY DIVISION REQUIREMENTS: By answering the following questions, HR processes the correct background check YES or NO Questions Answered By: Name / Phone Extension # Is Candidate under 18 years of Age? No background checks or ID badges issued for youth 15 & under. Is Candidate a City of Farmington Employee? Has Candidate ever been employed by the City of Farmington? Will Candidate Work with Youth? Will Candidate Work with the Public? Will Candidate Handle Cash Transactions? Will Candidate Handle Museum Collection or Exhibit Objects? Will Candidate Deliver Meals on Wheels to Homes of Senior Citizens? Will Candidate Operate City Vehicle? ---PAGE BREAK--- PRCA VOLUNTEER CANDIDATE INFORMATION PART 2 PAGE 2 OF 2