Volunteer Application

Volunteer Application Form

This online form is intended to provide the City with contact information and to learn about your background and interests as a potential member of a city advisory board or commission. Thank you for your interest in serving the City of Keizer! Please read the following waiver:

I have completed the questions below and, to the best of my knowledge, what has been stated is true. If appointed to a volunteer position, I agree to serve without reimbursement of any kind and with the understanding and agreement that medical insurance is not provided by the City of Keizer. Volunteers for the City of Keizer are covered under the City's liability insurance and workers compensation program. As a volunteer applicant, I understand that I may be subject to a criminal records check. I further understand the irrespective of any criminal records check, the City of Keizer may decline my volunteer application or volunteer services at any time.

By submitting this application you acknowledge that you have read the waiver and authorize the City of Keizer to run a criminal background check if required.

 

First Name*:
Last Name*:
Email*:
Phone*:
Address*:
City*:
PLEASE CHECK ALL COMMITTEES OF INTEREST
Budget Committee :
Festivals Advisory Board :
Keizer Points of Interest :
Parks Advisory Board :
Planning Commission :
Public Art Commission :
Traffic Safety/Bikeways/Pedestrian :
Other :
Days and times of week available: *
How many hours a month are you available? *
Please explain why you are interested in serving. * :
Your knowledge, education and/or skills * :
I understand the time commitment & duties involved * : Yes No
Have you ever been convicted of a felony? * No Yes
Education Background
High School * :
Graduate or GED? *
College :
Degree :
Personal Reference
Name: *
Address * :
Phone: *
Current Place of Employment
Employer's Name :
Employer's Address :
Employer's Phone :
May we contact you at work? Yes No
Previous Volunteer Experience
Volunteer Agency :
Address:
Phone:
Duties:
I authorize a criminal background check if required :