2. Volunteer Application

   We consider applicants for volunteer positions without regard to race, color, religion, creed, gender, national origin, age, disability or veteran status, or any other legally protected status.

6. Contact Information
8. 01. Last Name*
9. 02. First Name*
11. 03. Street Address*
13. 04. City*
14. 05. State*
15. 06. Zip Code*
17. 07. Phone Number*
18. 08. Email Address*
20. 09. Preferred method of contact?

    1. Phone
    2. Email
24. Personal Information
26. 10. Age 16 or Older?*

    1. Yes
    2. No
27. 11. Are you a U.S. citizen or legally authorized to work in the U.S.?*

    1. Yes
    2. No
29. 12. Have you ever volunteered for the City of St. Peters before?*

    1. Yes
    2. No
30. 13. If Yes, please list where you volunteered and the dates:
32. 14. Are you related to any City official or employee by blood or marriage?

    1. Yes
    2. No
33. 15. If Yes, please list their name(s) and relationship to you:
35. 16. Present Situation

    1. Student
    2. Volunteer
    3. Not Employed
    4. Retired
    5. Employed
    6. Other
36. 17a. Education

    1. 1
    2. 2
    3. 3
    4. 4
    5. 5
    6. 6
    7. 7
    8. 8
    9. 9
    10. 10
    11. 11
    12. 12
37. 17b. College

    1. 1
    2. 2
    3. 3
    4. 4+
39. 18. Name of School

    (if attending)

40. 19. Name of Current or Most Recent Employer
41. 20. Dates Employed
45. If you have volunteered for an organization other than the City of St. Peters, please list them.
47. 21. Organization(s)
48. 22. Volunteer Work Performed and Dates You Performed Them
52. Volunteer Work Desired
54. 23. Type of Work Desired
55. 24. Availability

    1. Short Term
    2. Long Term
    3. Special Events
    4. On-Call / As Needed

    (check all that apply)

57. 25. Are any special accommodations required?

    1. Yes
    2. No
58. 26. If Yes, please explain
62. In Case of Emergency Please Contact
64. 27. Last Name
65. 28. First Name*
67. 29a. Phone Number*
68. 29b. Phone Extension
72. Personal or Work Reference

    (do not include relatives or family members)

74. 30. Last Name*
75. 31. First Name*
77. 32a. Phone Number*
78. 32b. Phone Extension
80. 33. Relationship
82. Acknowledgement

    I understand that I must satisfactorily undergo a screening process conducted by the City of St. Peters ("the City") before I am accepted as a volunteer. This information may consist of information about my personal characteristics, character, general reputation, and lifestyle as they relate to my ability to perform the volunteer position for which I have applied. The City will rely on the results of this check as a factor in determining whether I am an acceptable volunteer.

    Please read and sign the following:

    I authorize the City to conduct a background investigation of me. I agree that the City may request information from various federal, state, and other agencies, including public and private sources that maintain records concerning my past activities relating to my driving record, criminal record, civil matters, previous employment, educational background and professional licensing.

    I authorize any parties contacted to release information to the City regarding my previous employment, criminal history, driving record, academic records, licenses and certifications, and any other information.

    I understand that the City cannot guarantee the accuracy of any information reported to it by third parties, and I release the City from liability for damages that arise from errors or omissions in my background investigation.

    I certify that all of the information I provided is true and complete to the best of my knowledge. I understand that if any of the information I have provided is found false or has been omitted, that such false statements or omissions may be grounds for my rejection or termination of my employment.

    In lieu of your handwritten signature, by typing your name in the box below, you are agreeing to the above:

84. 34. Signature*

    (enter your name)

Leave This Blank:


86. 1. Receive an email copy of this form.
87. Email address

    This field is not part of the form submission.

88. Submit

* indicates a required field