Personal Information

First name

Last name

What is your Age Group?

Multi-line address

Country/Region

Address

City

Zip / Postal code

Phone

Email

Have you ever been convicted of, pleaded “No Contest” or guilty for any offenses other than traffic violations?(A criminal record will not automatically bar you from volunteering)

Yes

No

If "YES" please explain:

Are you a registered sex offender?

Yes

No

Emergency Contact Information

Name:

Relationship:

Address

Phone Number

Volunteer Information

Type of Volunteer

Volunteer

Community Service/School Credit

If court ordered briefly explain the charges resulting in your community service hours

Volunteer Location ( Areas of Interest):

Volunteer position your applying for if any:

Volunteer Policy

Review Volunteer Policy Here https://cms1files.revize.com/uintahcountyut/document_center/HR/PolicyManual/340%20Volunteers%20&%20Agents%20(1).pdf

Health Statement:

To ensure the proper placement of all volunteers, we request that you answer the following questions:

Do you have a disability that might affect your performance or create a hazard to yourself or others in connection with the job you are volunteering for?

By signing this application I confirm that the information provided is accurate and that I have reviewed the Volunteer Policy in its intertie. I hereby volunteer my services, as described in the Volunteer Work Description received to assist Uintah County in its authorized work.

Volunteer Signature

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Date

Month

Day

Year

I am authorized to allow volunteer services of the individual above

Signature of Parent/Guardian if volunteer is under age 18

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Date

Month

Day

Year

Identification

Please upload a current picture ID to go with your application. (Drivers License, State ID, Student ID for minors, etc.)

Volunteer Application