Volunteer Application

Please complete this form if you are an individual wishing to volunteer your time. If you represent a group or organization, please contact City Hall at 636-561-1718. We consider applicants for volunteer positions without regard to race, color, religion, creed, gender, national origin, age, disability, veteran status, or any other legally protected status.

Name*

Full Address*

Phone Number*

Email Address*

Are you 18 years or older?*

Yes

Are you a U.S. citizen or legally authorized to work in the U.S.?*

Yes

Have you ever volunteered for the City of Dardenne Prairie before?*

Yes

Are you seeking service hours to fulfill a requirement?*

Yes

If yes, please explain including contact information for your sponsor:

Present Situation*

Employed

Retired

Student

Not Employed

Organization

Other

Special Skills, Training or Hobbies:

Do you wish to be involved with (check all that apply):*

Special Events and Festivals

Senior Events

Environmental (outdoors)

Office Work

Working with Children

As Needed

Volunteer Experience and work performed:

Availability:?

Short Term

Long Term

Days Available:*

Monday

Tuesday

Wednesday

Thursday

Friday

Saturday

Sunday

Are any special accommodations required?*

Yes

If yes, please explain

Emergency contact name and phone number:*

Personal or Work Reference (Name and contact information):*

I understand that I must satisfactorily undergo a screening process conducted by the City of Dardenne Prairie (“the City”) before I am accepted as a volunteer. This information may consist of information about my personal characteristics, character, general reputation, and lifestyle as they relate to my ability to perform the volunteer position for which I have applied. I may also be required to provide a background check and/or drug testing. The City will rely on the results of this check as a factor in determining whether I will become a member of the Dardenne Prairie Volunteer Corp.

Please read and acknowledge the following: I authorize the City to conduct a background investigation of me. I agree that the City may request information from various federal, state, and other agencies, including public and private sources that maintain records concerning my past activities relating to my driving record, criminal record, civil matters, previous employment, educational background and professional licensing. I authorize any parties contacted to release information to the City regarding my previous employment, criminal history, driving record, academic records, licenses and certifications, and any other information. I understand that the City cannot guarantee the accuracy of any information reported to it by third parties, and I release the City from liability for damages that arise from errors or omissions in my background investigation. I certify that all of the information I have provided is true and complete to the best of my knowledge. I understand that if any of the information I have provided is found false or has been omitted, that such false statements or omissions for my rejection or termination of my employment.

Full Name*

Date Field*