Volunteer Application Contact Information First Name * Last Name * Preference Preference Name Name Pronoun Pronoun Address Address Address Address City City State/Province State/Province Zip/Postal Zip/Postal Country AfghanistanAland IslandsAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBruneiBulgariaBurkina FasoBurundiCôte d'IvoireCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos (Keeling) IslandsColombiaComorosCongoCook IslandsCosta RicaCroatiaCubaCuracaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFalkland Islands (Malvinas)Faroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestinePanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarReunionRomaniaRussiaRwandaSaint BarthelemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint Martin (French part)Saint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint Maarten (Dutch part)SlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUnited States Minor Outlying IslandsUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabwe Country Over 18? * Yes No (Guardian permission waiver required if under 18.) Phone Email * Employer (Optional) Employer Phone Emergency Contact First Name * Last Name * Main Phone * Relationship to You * Education List education (schools attended, degree(s) received, or high school if applicable): * If you are currently a student, where are you enrolled, and what is your area of study? * How did you hear about us? * References Please list one business, school, or volunteer reference - not relatives - that we may contact regarding your application Reference First Name * Last Name * Title Phone Email * Relationship to You * Volunteer Opportunities Select one or more * Cemetery Curatorial Volunteer Education & Outreach Front Desk & Museum Store Garage Sale Research Library Special Events Availability The History Center is generally open for volunteer work Monday through Saturday, 10am - 4pm, and for special events. Please give specific times you are available to volunteer or make note of times you can help with special events. Monday Tuesday Wednesday Thursday Friday Saturday I am only available evenings. Call me to work special events. Please list any previous experiences in museums, libraries, archives, records management, graphic design, social media, or technology. Do you possess any other skills in the areas listed above that you would like to bring to the MCHC? Please specify any specific needs or limitations while volunteering at the MCHC. Background Check As an organization that regularly works with school-aged children and at-risk populations, we conduct background checks for all volunteer applications. Please complete the information below. Birth date * Have you ever been convicted of a crime? * Yes No (If yes) Charge * (If yes) State and County of Charge * (If yes) Sentence * (If yes) Do you have community service hours to fulfill? How many hours do you need to fulfill? * (If yes) By what date must these hours be fulfilled? * **Please read the following statements** As a volunteer or intern of the Monroe County History Center. I will try to do the following to the best of my abilities. If I fail to do so I understand that I can be released from my duties. • I will maintain contact with my supervisor(s). • I will maintain a reasonable appearance. • I will treat all patrons, volunteers, interns, and staff with the utmost respect and dignity. • I will arrive at the desired location (History Center or elsewhere) at the previously arranged time. If I am unable to do so I will try to contact the History Center to notify someone. • I understand that I can approach the Volunteer/Intern Coordinator with any problems that I may have regarding my duties or interpersonal relations relating to the History Center. • I understand that I can approach the Executive Director or Board President if the Volunteer/Intern Coordinator can not solve the above mentioned problems. • I have notified the Volunteer/Intern Coordinator of any special needs that I may have. I certify that the statements made in this volunteer application are true and correct, and have been given voluntarily. I understand that misrepresentation is cause for dismissal. I understand that a background investigation check will be made whereby information is obtained through personal interviews, a criminal background check, and other sources that have information about me. I hereby grant permission and consent to any such verification and investigation, agree to cooperate in same, and release from all liability or responsibility all persons, organizations, companies and corporations collecting and supplying information. My services are donated to the Monroe County History Center without contemplation of compensation or future employment and given for charitable reasons. I understand that failure to follow MCHC policies and procedure may be cause for dismissal. I agree to uphold the MCHC mission of historical preservation, exhibitions and education through my actions and words. I also assume the risk of injury and all medical expense incurred from any injury resulting from my volunteer participation. I understand, acknowledge, and agree that I am not covered by Workers’ Compensation insurance or benefits provided thereunder and I do hereby release, discharge, and hold harmless the Monroe County History Center, its agents, representatives and employees, from any and all claims whatsoever, known or unknown, for damages or injuries to myself. * I have read all the above If you are human, leave this field blank. Submit
