Please complete the following form.

Personal Information

Name*

Address*

City

State

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Zip Code

Email Address*

Preferred Phone Number*

Date of Birth *

Gender

Male

Female

Do you hold a valid driver's license?

Yes

No

Education

Please check the highest level attended or completed

High School Some College

College Graduate School

Name of school

Major/ Field of Study

Special training, licenses, professional registration, and skills:

Employment

I am presently (Check as many that apply)

Full Time employed Part Time employed Self employed

Unemployed Student Retired

Availability

Time available for volunteer work

Morning Afternoon

Evenings Seasonal

Hours per day (number per day)*

Times per week (number of times) *

Days per week (Check the days that can work)

Monday Tuesday Wednesday Thursday

Friday Saturday Sunday

Volunteer Opportunity Term

Long Term

Short Term

What are some skills and talents that you bring?

Depending on the department a background check could be required?

City Department Placement

In which general areas are you interested in spending your time? (please check as many as apply)

Arts and Culture City Manager Code Enforcement Environmental Initiatives LEAP - Literacy for Every Adult Program

Recreation Department Open to volunteer opportunities with partnering agencies Community Program Library - Homework Help Program Library - Richmond Summer Reading Heroes

What specific tasks are you interested in? For example, clerical support, tutoring, greeting visitors.

Languages

Fluent Languages (other than English)

Emergency

In case of an emergency please notify: *

Relationship: *

Phone: *

References

Name, phone number, and email address:*

Name, phone, number, and email address:*

Name, phone, number, and email address:*

Criminal Convictions

Have you ever been convicted of a crime? (A yes will not disqualify you).

Yes

No

If yes, please explain

Are you currently being charged with a crime that has not yet resulted in a plea of guilty, court trial, deferred adjudication, or dropping of the charge(s)? (A yes will not disqualify you).

Yes

No

If yes, please explain

Describe your most recent volunteer experience?*

Terms and Conditions

Please carefully read the following statements.

I agree to volunteer my services to the CITY OF RICHMOND, California("City") or a partnering agency.

I acknowledge that there is no salary or other compensation of any kind to be provided by the City of Richmond for my
services as a volunteer.

I understand that the City of Richmond may photograph or videotape the events or activity in which I am (or my child is)
participating. I give my permission for the City to use photographs or videotape of me (or my child) for the purpose of
promoting the City of Richmond and its services/programs. I give my permission with the following understanding: No
compensation of any kind will be paid to me (or my child) at this time or in the future for the use of my (or my
child's) likeness.

The Program is under no obligation to accept all interested volunteers. Any or all of the following could be required before placement in certain volunteer positions: Fingerprinting or Background Investigation.

State law requires that all persons working with minors be fingerprinted and undergo a state and federal background check.

I hereby release the City of Richmond, its officers, agents and employees from any and all liability, claims, cause of action, or actions, arising out of or occasioned by bodily injuries or
property damages sustained by me as a result of my volunteer services to the City.

If volunteer is under 18 years of age, a parent’s/guardian’s phone number is required.

I understand that during the course and scope of my volunteer services to the City, I will be covered under the City's Worker's Compensation self-insurance. I also understand and agree that my sole remedy for any injury that I may sustain during the course and scope of my volunteer services to the City, which is covered by Worker's Compensation, shall be through the City's Worker's Compensation self-insurance coverage. I waive any other right or remedy that I may have available to me for the injuries described above.

I also acknowledge and agree that my services are provided for the convenience of the City and may be terminated for any reasonor for no reasonand at any time by the City without notice or hearing.

I, the undersigned, certify that the information stated on this application is true, complete and correct to the best of my knowledge and belief and is made in good faith. Any false statements made by me may be used as a basis of rejection for this application.

I further state that I have carefully read the foregoing release and agreement and know the contents thereof, and agree as my own free accord. Please enter "agree" if you agree to the terms and conditions.

If you are under the age of 18, please include your parent's phone number to confirm permission has been granted.

How did you find out about us?

City of Richmond Webpage A Friend Flyer

Facebook Twitter Other

If you checked other, please specify.

Why did you become interested in volunteering with Richmond?