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Lewiston Municipal Volunteer Program 0BVolunteer Application 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. 1BCONTACT!INFORMATION!&!PERSONAL!DATA*! ! ! ! ! ! ! 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! ! 1 ---PAGE BREAK--- 2 ! ! ! 2BSPECIAL!SKILLS!AND!ABILITIES! (Please!check!all!that!apply.)! ! ____!Enjoy!working!with!numbers! _____!Skilled!in!Microsoft!Office! ! _____!Strong!organizational!skills! ! !_____!Painting,!carpentry!(circle!one!or!both)! ! ____!Keyboarding;!data!entry!!!!!!!!!!!!!!!!!!!!!!!!!!_____!Research!capabilities! ! ____!Public!speaking!! ! !_____!Shelving/mending!books! ____!Outdoor/indoor!recreation! ! !_____!Gardening! ! ____!Web!site!maintenance! ! ! !_____!Multi"tasking!!! ! ____!Bi"lingual! ! ! ! ! ! 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!check!the!days!of!the!week!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!_____________! ! ! Have!you!ever!been!convicted!of!a!felony!___!Yes!!!_____!No.!!Have!you!ever!been! convicted!of!a!misdemeanor!other!than!minor!traffic!expenses?!!If!yes,!please!explain:! ! 6BVOLUNTEER!AGREEMENT! *A!criminal!background!check!will!be!conducted!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!! on!all!applicants!being!considered!for!City!of!Lewiston!volunteer!service.!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!! 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!criminal!record,!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.!!!!!! ! ! ! (Electronic!signature!is!permitted!for!online!submission.!!However,!if!an!application!is! completed!online,!the!person!applying!to!volunteer!will!need!to!physically!sign!his/her! application!during!the!initial!screening!interview!with!the!Community!Relations!