1. law, govt and politics
2. law enforcement
3. fire department

CITY OF LINCOLN
VOLUNTEER SERVICE APPLICATION
edited for
Lincoln City Libraries
YOUTH VOLUNTEERS
PLEASE PRINT
GENERAL
Name:_______________________________________________________________________________
(Last)
(First)
(Middle)
(Suffix)
_______________________
(Birth Date)
_____________________
(Current Age)
_______________________
(Gender)
CURRENT ADDRESS
_____________________________________________________________________________________
(Street)
(City)
(State)
(ZIP Code)
(____)_________________
(Day Phone)
(____)________________
(Evening Phone)
(____)______________
(Cell Phone)
EMERGENCY
Emergency Contact:____________________________________________________________________
(Last Name)
(First Name)
(Middle Name)
(____)___________________________
( Phone)
_____________________________________________
(Relationship)
CRIMINAL HISTORY CHECK
Yes No
(Check one)
If yes, please list All convictions for any law violation (i.e. DUI, shoplifting, minor in possession, reckless driving,
etc.) other than a minor traffic violation (i.e. parking ticket, speeding ticket) including convictions that have been set
aside, probationed and/or pardoned, must be listed on the application or included in writing on an attached sheet.
Consideration is given to the offense and its relationship to the position for which you are applying. Failure to list
convictions on this form will be considered falsification of your application and will result in automatic rejection.
Have you ever been convicted of any violation of law other than a minor traffic violation?
A conviction will not automatically disqualify you from consideration. We will consider the nature of the offense in
relation to the volunteer duties. We also will consider your record since the offense was committed.
Date:__________ Charges:___________________________________ City/State:___________________
Date:__________ Charges:___________________________________ City/State:___________________
Explanation: __________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
Please list all states where you have resided: _________________________________________________
SIGNATURE / CERTIFICATION
I certify that all statements in this application are true. I also agree that if I am accepted as a volunteer, I
will do my best to abide by all policies and ordinances of the City of Lincoln.
____________________________________________________________________________________
(Volunteer Signature)
(Date)
____________________________________________________________________________________
(Parent Signature)
(Date)
CHECKLIST OF THINGS TO DO IN ORDER TO BECOME A
LINCOLN CITY LIBRARIES
Summer Reading Volunteer
_____ Sign up starting April 15th at the Lincoln City Libraries location of your choice.
You will choose the hours that you would like to volunteer at that time. (If volunteering
at Gere Branch, the completed registration form and signed volunteer contract must be
returned before you can sign up for a time slot.) IMPORTANT: You are required to sign
up for a time slot before attending training.
_____ Complete the registration form, including the permission section.
_____ Attend MANDATORY training at the location where you will be volunteering.
Bring the completed registration form to the training session you attend. All information
must be complete on your form in order to volunteer.
TRAINING SESSION SCHEDULE:
Anderson Branch, 3635 Touzalin Avenue
Monday
Wednesday
May 18
May 20
4:00-4:45 p.m.
5:00-5:45 p.m.
Bennett Martin Public Library, 136 S. 14th Street
Saturday
Saturday
May 16
May 23
10:30 a.m.-12:00 p.m.
10:30 a.m.-12:00 p.m.
Bethany Branch, 1810 N. Cotner Blvd.
Tuesday
Wednesday
May 19
May 20
4:00-4:45 p.m.
5:00-5:45 p.m.
Eiseley Branch, 1530 Superior Street
Monday
Tuesday
Thursday
Tuesday
May 18
May 19
May 21
May 26
6:30-7:30 p.m.
4:30-5:30 p.m.
6:30-7:30 p.m.
2:30-3:30 p.m.
South Branch, 2675 South Street
Monday
Thursday
May 18
May 21
6:30-7:15 p.m.
4:00-4:45 p.m.
(over - more training options on back)
TRAINING SESSION SCHEDULE, CONTINUED:
Walt Branch, 6701 S. 14th Street
Returning Volunteers:
Saturday
Thursday
May 9
May 14
10:30-11:30 a.m.
6:00-7:00 p.m.
First Time Volunteers:
Saturday
Monday
May 16
May 18
10:30 a.m.-12:00 p.m.
6:00-7:30 p.m.
Williams Branch, 5000 Mike Scholl Street (Arnold Elementary)
Thursday
May 21
4:30-5:30 p.m
Tuesday
May 12
5:20-7:00 p.m.
5:40-7:20 p.m.
6:00-7:40 p.m.
Friday
May 15
3:20-5:00 p.m.
3:40-5:20 p.m.
4:00-5:40 p.m.
Saturday
May 16
10:20 a.m.-12:00 p.m.
10:40 a.m.-12:20 p.m.
11:00 a.m.-12:40 p.m.
2:20-4:00 p.m.
2:40-4:20 p.m.
3:00-4:40 p.m.
Gere Branch, 2400 S. 56th Street
NOTICE
To ensure a quality experience for both summer reading volunteers
and library customers, volunteer training is mandatory, no
exceptions. Arrangements must be made prior to training if a
volunteer is unable to attend a scheduled training session.
2015 Summer Volunteer Program
Lincoln City Libraries
VOLUNTEER INFORMATION
Name _______________________________________________________
Address _____________________________________________________
Please include your zip code.
Phone Number ________________________________________________
Email Address ________________________________________________
School Attending in Fall________________________________________
Grade in Fall (open to grades 6 and up) ____________________________
Library Volunteering at _________________________________________
Please list any special talents or skills that you feel might be relevant to volunteering
____________________________________________________________________
Please tell us what your expectations are about this volunteer experience.
(What type of jobs do you want to be involved in?) __________________________
____________________________________________________________________
_________________________________________________
PERMISSION
(Must be completed by parent or guardian before volunteering)
__________________________________ has
my permission to work as a
Summer Reading Volunteer at Lincoln City Libraries.
__________________________________________
Parent/Guardian Signature
_________________________
Date
_________________________________________________
EMERGENCY CONTACTS: (Please list two)
1. Name ____________________________________________________________
Daytime Phone Number _____________________________
Evening Phone Number _____________________________
What is their relationship to you? ______________________
2. Name ____________________________________________________________
Daytime Phone Number _____________________________
Evening Phone Number _____________________________
What is their relationship to you? ______________________
RELEASE FORM
PHOTOGRAPHS/RECORDED IMAGES/VOICES
GRANTED TO: City of Lincoln, Lincoln City Libraries
I, ___________________________________________________, hereby authorize City of Lincoln/Lincoln
City Libraries, to use my image/voice for the purpose of promotion or public information without obtaining
further consent or without prior knowledge of such use. I understand that I am to receive no compensation of
any kind as a result of any publication, recording, broadcast, rebroadcast or other non-broadcast uses thereof.
I understand that my image/voice may be altered as required for publication or distribution. I hereby release
the City of Lincoln/Lincoln City Libraries, for any violation of any personal or proprietary right I may have in
connection with such use.
The City of Lincoln/Lincoln City Libraries shall have ownership of resultant production using my image and
shall have the exclusive right to make use of such production as stipulated below:
1. Availability for use in promotional brochures, newsletters, and other publications of City of Lincoln/Lincoln
City Libraries, and Foundation for Lincoln City Libraries;
2. Availability for Community Access broadcast, strictly a non-profit venue;
3. Availability for use on Web pages and other Internet sites created or used by the City of Lincoln/Lincoln
City Libraries, and Foundation for Lincoln City Libraries.
__________________________________________________________
Signature
Date
__________________________________________________________
If a Minor, Parent/Guardian Signature
Date
__________________________________________________________
Print Minor’s Name (first and last)
TO BE COMPLETED BY LIBRARY STAFF TAKING PHOTO/RECORDING:
Name of Staff Taking Photo/Recording:__________________________________________________
Date Photo/RecordingTaken:__________________________________________________________
Event/Location:_____________________________________________________________________
Where is Photo/Recording Filed? ______________________________________________________
Name of File:______________________________________________________________________
Forward completed form to Library Administration
Form Revised August 2013