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CANNON COUNTY LIBRARY VOLUNTEER APPLICATION

Please Fill out, print, and return to the Library.

Date: ______________________

Please complete and return this form to:

Adams Memorial Library

212 College St

Woodbury TN 37190

615-563-5861

Name:_________________________________ Phone:_________________________________

Address 1:_____________________________________Cell Phone:______________________

Address 2:_____________________________________Emergency Phone:________________

City:_____________________State:________________________Zip:____________________

Email:_______________________________________________________________________

Best time to call:_______________________________________________________________

Date of birth: (if under 18)___________________

AVAILABILITY

Branch Location preference: Auburntown or Woodbury (Please circle one).

_____ Regularly on a weekly basis for ______hour(s).

_____Weekday mornings _____Summers only _______Weekday afternoons

_____Evening programs _________ Saturdays _____September – June only

HIGHEST LEVEL OF EDUCATION

High School/GED ____ Associates' Degree ______Undergraduate Degree____

Graduate Degree_____Post-Graduate Degree____Other__________________

HAVE YOU EVER BEEN CONVICTED OF A FELONY? Yes____ No_____

REFERENCES (not living in the same household)

Name____________________________________Telephone_______________

Name____________________________________Telephone_______________

EMERGENCY CONTACT

Name:___________________________________Telephone_______________

I certify that all answers given by me are true, accurate and complete. I understand that the falsification, misrepresentation or omission of fact on this application will be cause for denial of volunteer employment and immediate termination of volunteer employment, regardless of when or how discovered.

I authorize the investigation of all statements and information contained on this application. I release from all liability anyone supplying such information and I also release the employer from all liability that might result from making an investigation.

I acknowledge that I have read and understand the above statement and hereby grant permission to confirm the information supplied on this application by me.

Signature_____________________________________Date________________________

WHAT AREAS OF VOLUNTEERING INTEREST YOU? (NOT ALL OPPORTUNITIES MAY BE AVAIALBLE AT ALL BRANCHES OR TIMES)

Shelving ______Services to homebound_______ Homework helper_______

Reader for the Blind or Physically Challenged______ Book reviewer______

Story time help____ Teen group helper____ Library Scrapbook ______Filing______

Computer user helper______ Library Marketing_____ Coupon Center helper_____

Summer reading helper_____ Craft helper_____

STUDENT VOLUNTEER PERMIT (if applicant is under 18 years of age)

____________________________ has my permission to work as a volunteer for the Cannon

County Library System. Student's date of birth:___________________________

Signature of adult/guardian: _____________________________Date:_______________