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2. What volunteer opportunity are you applying for? *
4. Full/Legal Name *

   First, Middle, Last

5. Date of Birth*
   Date of Birth
7. Note:

   If your application is approved, you will need to provide a social security number for an I9 form later during the onboarding process. 

9. Preferred Name and/or Pronouns
10. Primary Language(s) Spoken
12. Email*
13. Phone Number*
15. Address*
17. City*
18. State*
19. Zip Code*
21. Are you volunteering to complete a community service requirement? *

    1. Yes
    2. No
22. If yes, for

    1. School
    2. Court-ordered
    3. Other
23. If other, please specify
25. Emergency Contact Information
27. Full/Legal Name*

    First, Middle, Last

28. Relationship*
30. Home Phone*
31. Cell Phone*
32. Work Phone*
34. Email*
36. What skills make you a good fit for this position? Please list any pertinent skills, experience, and interests. *

    1. Arts and Crafts
    2. Gardening
    3. Cooking/Serving
    4. Office Work

    1. Event Coordination
    2. Sports
    3. Tutoring
    4. Visiting w/ Seniors
38. Please list any additional skills and previous experience: *
40. What makes you want to volunteer for the City of Winooski?*
42. Agreement

    I understand and agree that submitting this application form does not automatically register me as a City of Winooski volunteer, and that there may be certain qualifications I must meet, including the acceptance of established volunteer policies and procedures before I may begin volunteering. Volunteers younger than 18 years of age are considered minors and must have a parent or legal guardian agree to these volunteer terms by checking the box (below). By submitting this form, I attest that the information I have provided on the form is true and accurate.

    I hereby authorize the City of Winooski and its designated agents and representatives to conduct a criminal background check causing an investigative report to be generated for volunteer purposes. I understand that this background check will be processed through one or both the following entities: 

    • Vermont Crime Information Center 45 State Drive Waterbury, VT 05671-1300 Tel: 802 244 8727
    • Southeastern Security Consultants Inc (SSCI). 1853 Piedmont Rd Ste 100 Marietta GA 30066 866-996-7412 

    I understand that the scope of the report generated may include, but is not limited to the following areas: 

    • verification of social security number and/or birth date
    • current and previous residences
    • employment history
    • civil and criminal history records from any criminal justice agency in any or all federal, state, county jurisdictions,
    • driving records
    • and any other public records
44. By clicking yes, I hereby agree to the statements above and attest that all information provided by me is true and correct to the best of my knowledge.*

    1. Yes
46. Full Name*
47. Today's Date*
    Today's Date
48. Parent/Guardian Signature
49. Today's Date
    Today's Date
Leave This Blank:


51. 1. Receive an email copy of this form.
52. Email address

    This field is not part of the form submission.

53. Submit Submit and Print

* indicates a required field