Name       Date of Birth / /

Address (city, state, zip)

Home Phone ( ) -        E-mail

Emergency Contact Name    Phone # ( ) -  

Community Service:
Are you seeking hours for court appointed community service?     Yes No
If you answered Yes:
Total number of community service hours assigned
Total number of hours you'd like to serve at the Library
Deadline / /
Do you need confirmation of hours served in writing Yes No


For Teens:
Those under the age of 18 must have their parent or guardian sign the application.
Are you seeking hours for required community service for school or other organization   Yes No
If yes, how many hours
For what reason

Volunteer work preferred (please check all areas of interest):
Shelving
Adopt-a-Section (shelf-reading)
Hold Volunteer
Substitute Hold Volunteer
Seasonal/Special Occasion Displays
AV Material Cleaning & Repair
Cleaning Books/Dusting Shelves
Handyman
General Clerical
Friends of the LaGrange Library

Please list any skills and special knowledge you have which might be beneficial to the library
(e.g. clerical, computer, working with children, etc.):

Availability:
Would you prefer to have a regular work schedule or work on special projects within a more flexible time frame?

How many hours per week/month would you have to give to the library?

Which days/times are you available to volunteer?

References (work, volunteer, personal):
Please give the names of three references who know of your interests and abilities.

I understand that the LaGrange Library has the right to evaluate all applicants and will not accept a volunteer that would jeopardize the materials and services of the library or the safety of the library staff and patrons.

I understand that as a LaGrange Library volunteer I may come in contact with confidential information.  I agree to protect this information in compliance with the New York State Civil Practice Law and Rules 4509 and will not divulge any information during or after my services as a volunteer.

I agree to abide by all library policies and understand that as a library volunteer I am a representation of the library and must portray a positive image at all times.

I accept

I do no accept

I have read and agree to the above statement.  By accepting and submitting this application I understand that it will certify my signature and authorize LaGrange Library to make inquiry as to my experience and character, and to certify that all statements made on this application are true.