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2. Name
3. Email Address
5. Address
7. City
8. State
9. Zip Code
11. Phone Number
12. Are you over the age of 18? (If not, you must have parental consent.)

    1. Yes
    2. No
14. Do you have, or can you obtain a valid Washington State Driver's License?

    1. Yes
    2. No
15. Are you currently certified in CPR?

    1. Yes
    2. No
17. Are you currently certified in First Aid?

    1. Yes
    2. No
18. Do you have any medical conditions that should be taken into consideration in arranging volunteer assignments?

    1. Yes
    2. No
20. Have you been convicted of a felony or released from prison within the last ten (10) years, or have you been convicted of a misdemeanor other than minor traffic offenses within the past three (3) years?

    1. Yes
    2. No
21. If yes, please explain:
23. If yes, please explain:
24. What days of the week are you available (you may check more than one day)?

    1. Monday
    2. Tuesday
    3. Wednesday
    4. Thursday
    5. Friday
    6. Saturday
26. What hours are you generally available?

    1. Mornings
    2. Afternoons
27. Are you available in the evenings?

    1. Yes
    2. No
29. How many hours a day would you be willing to volunteer?

    1. 1-2 Hours
    2. 2-4 Hours
    3. 4-8 Hours
30. How many days a week would you be willing to volunteer?

    1. 1 day
    2. 2 days
    3. 3 days
    4. 4 days
    5. 5 days
32. What types of volunteer projects interest you?

    1. Long Term
    2. Short Term
    3. Special Projects
    4. Events
    5. Office
    6. Outdoor
33. Please check any of the following city activities that you are interested in volunteering for:

    1. Office work at City Hall
    2. General City or Community Events
    3. Parks & Recreation Events
    4. Senior Center
    5. Court Administration
    6. Parks & Facilities Maintenance
    7. Volunteers in Police Service
    8. Police Explorers
35. If interested in other activities, please explain.
36. To better match your skills, experience and education with volunteer opportunities at the City of Puyallup, please briefly tell us about yourself.
38. If there are volunteer opportunities for which you qualify, you will be called for an interview which will help to further determine where there is a good volunteer match. If so, the city will need to check references and conduct a WSP background check before a volunteer contract can be offered.
40. As part of this background check, the city will also need you to furnish three references who are not relatives. These references will only be contacted if you are being considered for a volunteer assignment.
42. Name of Reference # 1
43. Name of Reference #2
45. Telephone Number of Reference #1
46. Telephone Number of Reference #2
48. Relationship
49. Relationship
51. Name of Reference #3
53. Telephone Number of Reference #3
55. Relationship
57. To the best of my knowledge, the information herein is true and complete. I understand that falsification of this application is grounds for dismissal as a volunteer. Further, if I am interviewed, I give permission for an authorized representative of the city to conduct and Washington State Patrol background check in accordance with RCW 43.43.830-839 and to inquire of individuals about my ability to perform all aspects of the volunteer position for which I am being considered. I release the City of Puyallup and those individuals/institutions that provide information from any liability that may arise from the provision of the information.
59. I have read the above information and agree to the terms of this application.

    1. Yes
    2. No
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61. 1. Receive an email copy of this form.
62. Email address

    This field is not part of the form submission.

63. Submit

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