CANNON COUNTY LIBRARY VOLUNTEER APPLICATION
Date: ______________________
Please complete and return this form to: Adams Memorial Library
212 College St
Woodbury TN 37190
615-563-5861
Name:___________________________ Home 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 Woodbury (Please circle one).
_____Regularly on a weekly basis for ______hour(s). ________Weekday mornings
_____Summers only _________Weekday afternoons
_____Evening programs _________Saturdays
_____September – June only
AGE CATEGORIES (Please circle the group closest to your age)
12-17 18-29 30-54 55-64 65+
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________________
Reader for the Blind or
Physically Challenged_________________Homework helper_____________________
Book reviewer_______________________Storytime helper_____________________
Teen group helper____________________Library Scrapbook ____________________
Filing_______________________________Computer user helper_________________
Library Marketing_____________________Coupon Center helper_________________
Summer reading helper________________Craft helper_________________________
Courier service to and from Murfreesboro____________________________________
STUDENT VOLUNTEER PERMIT (if applicant is under 18 years of age)
____________________________ has my permission to work as a volunteer for the Cannon
(name)
County Library System. Student's date of birth:___________________________
Signature of adult/guardian_____________________________Date:_______________