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1 Lewiston Municipal Volunteer Program Volunteer Application 1BCONTACT INFORMATION & PERSONAL DATA* Name: Address: City: State Zip Code Telephone: Home: Work: Cell: E-mail: Do you possess a valid Maine State Driver’s License? Yes No If yes, what is your license number? Expiration Date / / Why do you want to be a volunteer? (Please use separate sheet if needed.) What would you like to do as a volunteer; do you have a preference? (Please use separate sheet if needed.) 7BUPURPOSE The purpose of the Municipal Volunteer Program is to connect City of Lewiston residents with municipal departments through active volunteer participation. Such interaction will benefit the City by providing a capable resource pool to assist employees and will benefit residents by providing a greater understanding of local government and an opportunity to make a difference. ---PAGE BREAK--- 2 2BSPECIAL SKILLS AND ABILITIES (Please check all that apply.) Enjoy working with numbers Skilled in Microsoft Office Alphabetical filing Strong organizational skills Customer service Painting, carpentry (choose one or both) Keyboarding; data entry Research capabilities Public speaking Shelving/mending books Outdoor/indoor recreation Gardening Web site maintenance Multi-tasking Bi-lingual Other (Please Specify) 3BPREVIOUS VOLUNTEER EXPERIENCES Organization Name Volunteer Duties Dates of Service - 4BEDUCATION School Major Focus (Post-secondary) Date of Graduation ---PAGE BREAK--- 3 WORK EXPERIENCE (Please use separate sheet if needed.) Briefly describe your current and/or past work experiences (duties & responsibilities). 5BAVAILABILITY (Please indicate days of week & preferred hours that you are available.) Monday Preferred hours to Tuesday Preferred hours to Wednesday Preferred hours to Thursday Preferred hours to Friday Preferred hours to Saturday Preferred hours to Sunday Preferred hours to REFERENCES (Please list two references other than family members.) Name Name Street Address Street Address City/State/Zip City/State/Zip Home Phone Home Phone Work Phone Work Phone Cell Phone Cell Phone ---PAGE BREAK--- 4 In case of emergency, please contact Phone Relationship to volunteer 6BVOLUNTEER AGREEMENT I understand that I am offering my services to the City of Lewiston without compensation. Once I become a City of Lewiston volunteer, I agree to abide by all City rules, regulations, and policies, either published or in effect by custom and usage and all rules, regulations, and laws of the State of Maine as may be required by City and State statutes. I understand that by signing this application, I hereby grant the City permission to perform a background check, including driving record, past employment, volunteer history, and personal references. I also understand that information collected during this background check will be limited to that appropriate to determine my suitability for particular types of available municipal volunteer work and that all such information collected during the background check will be kept confidential. I also understand that my service as a volunteer may be terminated at any time with or without cause; if terminated, I understand that I may not be considered for future volunteer duties within Lewiston municipal government. Signature: Date: *A background check will be conducted on all applicants being considered for City of Lewiston volunteer service.