Volunteer Interest Form

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Personal Information

First name

Middle initial

Last name

Email address

Street address

City

State

Zip code

Phone (Day)

Phone (Evening)

Contact address (if different than provided, above)

Phone (Alternate)

Please check if either of the following apply:

Volunteer Service Learning

Work Study Requirement

IF under age of 18, please provide date of birth:

Have you previously worked for WCPL?

Yes

No

If so, whom?

How did you hear about the WCPL Volunteer Program?

If you were referred by a current or former WCPL volunteer, please share their name

Employment & Volunteer Service Experience

Please list most recent experience first

Employment 1

Position Title

Position description

Start date

End date

Reason for leaving

Employer

Supervisor name

May we contact this employer?

Yes

No

Employer address

Employer phone

Employment 2

Position Title

Position description

Start date

End date

Reason for leaving

Employer

Supervisor name

May we contact this employer?

Yes

No

Employer phone

Employer address

Education & Training

Type of Degree:

College, University, or Technical School

Major subject:

Name of school:

GPA

City and state

High School

Name of high school:

City and state

Graduated?

Yes

No

Type of high school degree achieved:

GPA

References

List three (3), other than relatives or personal friends, who have knowledge of your experience and education.

Name and title

Mailing address

Phone number

Name and title

Mailing address

Phone number

Name and title

Mailing address

Phone number

APPLICATION MUST BE SIGNED PRIOR TO SUBMITTING
I hereby authorize investigation of all statements contained in this interest form and on my resume, if provided. I certify that such statements are true to the best of my knowledge and understand that misrepresentation or omission of facts called for in this form, or on any resume provided by me, may be cause for rejection or cause for termination of volunteer service and that only the Director of the Wayne County Public Library or his/her designee can make an offer of volunteer service with Wayne County Public Library. I also agree that you may contact the references, former employers and educational institutions as listed regarding this interest form and conduct a criminal background check and/or obtain DMV records as necessary for the volunteer position. I understand that I will not be paid for my services as a volunteer and I expect no compensation.

Print your name

NO PERSON SHALL BE DENIED A VOLUNTEER POSITION ON THE BASIS OF RACE, COLOR, ETHNICITY, NATIONAL ORIGIN, SEX/GENDER, SEXUAL ORIENTATION, RELIGION, CREED, DISABILITY (INCLUDING HIV STATUS), AGE, VETERAN STATUS, OR MARITAL STATUS. A VOLUNTEER POSITION IS CONTINGENT UPON FURNISHING EVIDENCE OF IDENTITY AND ELIGIBILITY.
Revision History: December 2006, September 2008, May 2009, May 2012, August 2014, January 2016, November 2016, June 2018

Volunteer Interest Form

Personal Information

Employment & Volunteer Service Experience

Education & Training

High School

Skills & Interests

References