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Trash Off Volunteer Application

  1. (First, Middle, Last)

  2. Gender

  3. Current Information:

  4. Previous Addresses

  5. Education/Experience

  6. Education Level

  7. Availability & Interests

  8. Volunteer Availability

    Please check all availability that apply for the Fall Trash Off - Saturday, September 20, 2014.

  9. Interests

    Please check all that apply.

  10. Other Interests

    We would like to keep your application on file should any future volunteer opportunities occur, we may contact you. What else you are interested in.

  11. WAIVER/RELEASE OF INFORMATION

  12. do understand and agree to the following:

  13. 1, I am not entitled to compensation for performance of my duties as a volunteer, nor any employee benefits, nor am I covered by any workers’ compensation. My liability coverage only covers official volunteer duties.

  14. 2. The offer to volunteer employment and consideration of continued volunteer employment is contingent upon acceptable review of information including but not limited to consumer credit history, criminal conviction history, driving record and other such reports that may exhibit information on my work habits, performance, education and experience, along with reason for termination of employment from previous employers where such information exists.

  15. 3. I knowingly and voluntarily authorize and consent to allow the City of Lancaster to request information from various Federal, State and other such agencies which maintain records concerning and relating to records that may contain my driving history, criminal history, credit history, civil history and other experiences. I hereby authorize without reservation any party or agency contacted by the City of Lancaster, as a condition of volunteer employment, to furnish the listed information on this application and to release and hold harmless all parties involved from any liability and responsibility for doing so. This authorization and consent shall be valid in its original, faxed or copy form.

  16. 4. I hereby agree to indemnify, defend and hold harmless the City of Lancaster, including its agents, employees or representatives, from any and all claims or causes of action, including any claims or causes of action resulting from the negligence or liability of the City of Lancaster, including its agents, employees or representatives, including, but not limited to, property damage, bodily injury or death arising out of or in any way connected to my participation in the City of Lancaster Volunteer Program.

  17. 5. I knowingly and voluntarily authorize and consent to allow the City of Lancaster to utilize my image or likeness for promotional purposes, both electronically and in print.

  18. 6. I certify that all information I have provided is true and correct.

  19. By printing your name above you are hereby agreeing to all the statements above, and the printed name above will be treated as an electronic signature.

  20. Parent/Guardian must authorize permission for background check on minor.

  21. Leave This Blank:

  22. This field is not part of the form submission.