Forms • Chelsea, AL • CivicEngage

First and Last Name*

Address *

Phone Number*

Email Address*

Occupation *

Name of employer*

What day(s) can you volunteer? Check all that apply.*

	Monday
	Tuesday
	Wednesday

	Thursday
	Friday
	Saturday

What time(s) can you volunteer? Check all that apply.*

	Morning
	Afternoon

Evening

When are you wanting to volunteer? Check all that apply.*

Summer

Year Round

Reason for volunteering.

*Please note: Court ordered community service must first be approved by library board.*

	Voluntary
	Scholarship

Court Ordered*

How many hours are needed?

Do you have any library experience? Whether as a volunteer or paid employee.*

Yes

No

Are you able to perform light physical duties?*

Yes

No

If "No", please explain.

What is your comfort level working with computers?*

	1 - Never used a computer
	2
	3

	4
	5 - Expert

Are you comfortable working with children?*

Yes

No

Please list any skills or talents you would be willing use while volunteering at the library.*

How do you use your local library?*

Please provide a reference contact(s). Include name, occupation, and contact information.

Emergency Contact*

Relationship*

Phone Number*

I have read and understand the Volunteer Policy of Chelsea Public Library as well as the Library Bill of Rights. I certify that the statements above are true and complete to the best of my knowledge. I understand that false statements shall be sufficient cause for my volunteer activities to be discontinued by the library. I acknowledge that the volunteer work i agree to perform may involve risk of personal injury; however, I agree to perform the assigned duties to me, and I will accept responsibility for my personal safety.

Please sign with your name.*

* indicates required fields.

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