2018 ADULT VOLUNTEER APPLICATION

Transcription

1 2018 ADULT VOLUNTEER APPLICATION 1100 Trevilian Way Louisville, KY (502) (Please Print) Mr. Miss Mrs. Ms. Jr. Sr. Dr II III IV NAME NICKNAME Home Address City State Zip Phone Birthdate Are You a Zoo Member? (Circle) Yes / No Driver s License No. State Expiration EMPLOYMENT Occupation Employer Business Address Skills and Special Interests Education (list any attended): College High School Other In case of emergency, please notify: Name Relationship (Parent, Spouse, etc.) Phone (Home) Phone (Work) Have you had experience working with youth in other organizations? (Please describe) Please list your community affiliations (churches, clubs, other organizations). How did you hear about the Volunteer Program at the Louisville Zoo? Why are you interested in Volunteer Service? Do you have any special needs? If so, please list so we may assist you.

2 REFERENCES: Please list those who are familiar with your character as it relates to working with youth or adults. References will be checked. (#1) Name Address Zip Phone (#2) Name Address Zip Phone ADDITIONAL INFORMATION: a. Do you use illegal drugs? YES NO b. Have you ever been convicted of a criminal offense? YES NO c. Have you ever been charged with child neglect or abuse? (If yes, explain below) YES NO d. Has your driver s license ever been suspended? YES NO e. Have you ever been cited for a moving traffic violation? (If yes, write the date and dispositon of the citation below) YES NO f. Other than the above, is there any fact or circumstance involving your background that would call into question your being entrusted with the supervision, guidance and working with young people (If yes, explain below) YES NO TYPES OF VOLUNTEER OPPORTUNITIES AVAILABLE (job duties will be explained in detail during interview). Please check one or more areas that interest you. Adopt a Garden Animal Area (August June) Animal Health Center Docent (Training required) Internships Upon Request Horticulture Special Events Greeter (Distributes brochures, greets guests at the front gate) March September SCHEDULE Please check the day you would be available to volunteer (MUST BE AVAILABLE AT 8:00 A.M. Some areas 7:30 a.m.) Sunday Tuesday Thursday Saturday Monday Wednesday Friday I UNDERSTAND THAT: a. The information that I have provided may be verified, if necessary, by contacting persons or organizations in this application, or by contacting any person or organization that may have information concerning me with the exception of sealed records or information retained by juvenile court. I hereby release and agree to hold harmless from liability any person or organization that provides information. I also agree to hold harmless the Louisville Zoo, employees, and volunteer thereof. b. In signing this application, I have read the attached information and apply for registration with the Louisville Zoological Garden. I agree to be guided by the rules and regualtions of the Louisville Zoological Garden. I affirm that the information I have given on this form is true and correct. Signature Date PLEASE NOTE: AN UPDATED TB TEST IS REQUIRED BEFORE VOLUNTEERING IN SOME AREAS. Test is not required for Greeters, Special Events, Horticulture or Adopt a Garden.

3 Applicant Release and Authorization The purpose of this form is to notify you that a Consumer Report and/or an Investigative Consumer Report will be conducted on you in the course of consideration for employment or promotion. This report is being provided by Inquiries, Inc.- Post Office Box 67 Easton, MD Phone I hereby authorize your company or any agent of your company to contact any and all corporations, former employers, credit agencies, educational institutions, law enforcement agencies, workers compensation agencies, city, state, county, and federal courts and military services to release information about my background including, but not limited to, information about my employment, education, consumer credit history, workers compensation claims, driving record, criminal record, and general public records history to the person or company with which this form has been filed. This release also authorizes the client to request a pre-employment and/or random selection drug screen. This releases the aforesaid parties from any liability and responsibility for collecting the above information. This release shall remain in effect for the length of my employment. I understand I have the right to obtain a free copy of this Consumer Report if; (1) Any adverse action/decision is made based on the information in the consumer report, & (2) If the request is made in writing within 60 days of the adverse action. I believe to the best of my knowledge that all information I have provided is accurate true and correct and that I fully understand the terms of this release. Please write clearly and fill out completely. Name (Last) (First) (Middle) List any maiden/other name used in the last 7 years Date of birth / / Social Security Number - - Drivers License # State Sex Race Professional License Held* State Lic.# (*only if requesting a professional license verification) List your current mailing address as well as any other cities or towns you have lived in the past 7 years: Street or PO# City State Zip Your Signature Today's Date / / Minnesota, California, and Oklahoma applicants only. If you want a copy of the reports ordered, check this box. The report(s) will be sent by the reporting agency to you at the address below. A Consumer Report ***APPLICANT DO NOT WRITE BELOW THIS LINE*** In connection FAX TO: with your (410) application for employment, we TO may BE procure FILLED a OUT consumer BY COMPANY report on REQUESTING you as part of INFORMATION: the process of considering your candidacy Company as employee. Name: Branch In the event that information from the report is utilized in whole or in part in making an adverse decision with regard to your potential employment, before making the adverse decision, we will provide you with a copy of the consumer report Please and a start description our standard in writing background of your check rights (ignore under boxes the below) law. Or select from the following: Please be advised that we may also obtain an investigative report including information as to your character, general County Criminal History Statewide Criminal History Civil History Social Security Verification reputation, personal characteristics, and mode of living. This information may be obtained by contacting your previous employers or references Education/Degree supplied by Verification you. Please be Driving advised Record that you National have the Wants right & to Warrants request, in Fingerprint writing, Services within a reasonable time, that we make a complete and accurate disclosure of the nature and scope of the information requested. Such disclosure will be made to you Previous within 5 Employer days of Verification the date on which Federal we receive District the Criminal request Search from you OFAC or within List Check 5 days of HHS/OIG/EPLS the time the Scan report was first requested. Sex Offender National Sex Offender Credit Report The Fair Credit Reporting Act gives you specific rights in dealing with consumer reporting agencies. You will be given a human error in the actual recording of the record. Since this information is not owned by Inquiries, Inc. and since public records data on any one individual, group of summary of these rights together with this document. While the information contained in the reports provided has been obtained from public records data sources deemed reliable, its accuracy cannot be guaranteed due to potential individuals, company, or companies can be contained in more than one repository Inquiries, Inc. can only rely on its accuracy from the public records data sources presently available at the time of the search. This information is furnished for your exclusive use and accepted by you without any liability on the part of Inquiries, Inc. its sources, officers, agents or employees. Furthermore you agree to indemnify Inquiries, Inc, its sources, agents, and employees of any liability for the use of this information and shall agree that the right to obtain and the purpose for this information, for your exclusive use, is fully within the appropriate law or laws which apply to the permissible purpose of retrieving background information on an individuals criminal records history, and / or workers compensation claim history. Disclosure to Employment Applicant

4 Applicant Release and Authorization In connection with your application for employment, we may procure a consumer report on you as part of the process of considering your candidacy as an employee. In the event that information from the report is utilized in whole or in part in making an adverse decision with regard to your potential employment, before making the adverse decision, we will provide you with a copy of the consumer report and a description in writing of your rights under the law. Please be advised that we may also obtain an investigative report including information as to your character, general reputation, personal characteristics, and mode of living. This information may be obtained by contacting your previous employers or references supplied by you. Please be advised that you have the right to request, in writing, within a reasonable time, that we make a complete and accurate disclosure of the nature and scope of the information requested. Such disclosure will be made to you within 5 days of the date on which we receive the request from you or within 5 days of the time the report was first requested. The Fair Credit Reporting Act gives you specific rights in dealing with consumer reporting agencies. You will be given a summary of these rights together with this document. By your signature below, you hereby authorize us to obtain a consumer report and/or an investigative report about you in order to consider you for employment. Applicant s Name: Applicant s Address: City/State/Zip: Signature: (Please Print) Social Security Number: Give copy with Summary of Rights to applicant. Retain a copy for your files.

5 Louisville/Jefferson County Metro Government Department: Zoo