Volunteer Form Contact Information First Name * Last Name * Address Address Address Address City City State/Province State/Province Zip/Postal Zip/Postal Country Afghanistan Aland Islands Albania Algeria American Samoa Andorra Angola Anguilla Antarctica Antigua and Barbuda Argentina Armenia Aruba Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bermuda Bhutan Bolivia Bonaire, Sint Eustatius and Saba Bosnia and Herzegovina Botswana Bouvet Island Brazil British Indian Ocean Territory Brunei Bulgaria Burkina Faso Burundi Côte d'Ivoire Cambodia Cameroon Canada Cape Verde Cayman Islands Central African Republic Chad Chile China Christmas Island Cocos (Keeling) Islands Colombia Comoros Congo Cook Islands Costa Rica Croatia Cuba Curacao Cyprus Czech Republic Denmark Djibouti Dominica Dominican Republic East Timor Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Ethiopia Falkland Islands (Malvinas) Faroe Islands Fiji Finland France French Guiana French Polynesia French Southern Territories Gabon Gambia Georgia Germany Ghana Gibraltar Greece Greenland Grenada Guadeloupe Guam Guatemala Guernsey Guinea Guinea-Bissau Guyana Haiti Heard Island and McDonald Islands Holy See Honduras Hong Kong Hungary Iceland India Indonesia Iran Iraq Ireland Isle of Man Israel Italy Jamaica Japan Jersey Jordan Kazakhstan Kenya Kiribati Kosovo Kuwait Kyrgyzstan Laos Latvia Lebanon Lesotho Liberia Libya Liechtenstein Lithuania Luxembourg Macao Macedonia Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Martinique Mauritania Mauritius Mayotte Mexico Micronesia Moldova Monaco Mongolia Montenegro Montserrat Morocco Mozambique Myanmar Namibia Nauru Nepal Netherlands New Caledonia New Zealand Nicaragua Niger Nigeria Niue Norfolk Island North Korea Northern Mariana Islands Norway Oman Pakistan Palau Palestine Panama Papua New Guinea Paraguay Peru Philippines Pitcairn Poland Portugal Puerto Rico Qatar Reunion Romania Russia Rwanda Saint Barthelemy Saint Helena, Ascension and Tristan da Cunha Saint Kitts and Nevis Saint Lucia Saint Martin (French part) Saint Pierre and Miquelon Saint Vincent and the Grenadines Samoa San Marino Sao Tome and Principe Saudi Arabia Senegal Serbia Seychelles Sierra Leone Singapore Sint Maarten (Dutch part) Slovakia Slovenia Solomon Islands Somalia South Africa South Georgia and the South Sandwich Islands South Korea South Sudan Spain Sri Lanka Sudan Suriname Svalbard and Jan Mayen Swaziland Sweden Switzerland Syria Taiwan Tajikistan Tanzania Thailand Timor-Leste Togo Tokelau Tonga Trinidad and Tobago Tunisia Turkey Turkmenistan Turks and Caicos Islands Tuvalu Uganda Ukraine United Arab Emirates United Kingdom United States United States Minor Outlying Islands Uruguay Uzbekistan Vanuatu Vatican City Venezuela Vietnam Virgin Islands, British Virgin Islands, U.S. Wallis and Futuna Western Sahara Yemen Zambia Zimbabwe Country Over 18? * Yes No (Guardian signature required on last page if under 18.) Birth date * Home Phone Cell Phone Email * Employer Employer Phone Emergency Contact First Name * Last Name * Main Phone * Relationship to You * Education List school(s) attended and degree(s) received. * List schools attended/degree(s) received, beginning with high school: Are you currently a student? * Yes No If yes, where 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 * Criminal History 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? * Position Descriptions Select one or more * Permanent Collections Intern/Volunteer Archival Intern/Volunteer Textiles Intern/Volunteer Exhibits Research Library Greeter Education Please list any previous experiences in museums, libraries, archives, records management, graphic design, social media, or technology. Do you possess any other skills that may be valuable at the History Center (especially museum or library skills)? Please specify any limitations or requests that you may have involving volunteering at MCHC. Please indicate the type of position you would like: * For-Credit Internship (*approval required) Volunteering *For-credit internships require the signature of your academic advisor on a contract. Position Title/Department: * Number of hours per week requested * Available Start Date * Please check the type projects that interest you * Short-term projects (A few hours per month) On-going projects (2-4 hours per week) One-time/Occasional projects (Special events) Special Skills: Please check all that apply. General Research Genealogical Research Education Librarianship Teaching Writing/ Editing Customer Service Microsoft Word Excel Other general skills Availability The History Center is open to the public Tuesday through Saturday 10 a.m. to 4 p.m. The Center is open Monday to staff and volunteers. Generally your volunteer time will be during our regularly scheduled hours. However, occasionally there are special events that require volunteers outside these hours. Please give specific times you are available to volunteer Monday through Saturday. Monday Tuesday Wednesday Thursday Friday Saturday I am only available evenings. Call me to work special events. **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
