2. If you are under the age of 18 this application requires a parent or guardians signature.
4. First Name
5. Last Name
7. Address1
9. City
10. State
11. Zip
13. Date of Birth:
14. Phone Number:
15. Email (if applicable):
17. Please check all that apply

    What day(s) of the week are you available?

    1. Sunday
    2. Monday
    3. Tuesday
    4. Wednesday
    5. Thursday
    6. Friday
    7. Saturday
18. What time(s) are you available to work?

    1. Mornings: 9:00am-1:00pm
    2. Afternoons: 1:00pm-5:00pm
    3. Evenings: 5:00pm-9:00pm
19. How often can you volunteer?

    1. 3 X a week
    2. 2 X a week
    3. 1 X a week
21. Please list the following:
23. Special Skills or Interests: music, art, computers, typing, writing, working with children etc.
25. Previous Volunteer Experience:
27. References: Please list three with phone numbers.
29. Name:
30. Phone Number:
31. Relationship:
33. Name:
34. Phone Number:
35. Relationship:
37. Name:
38. Phone Number:
39. Relationship
41. Please sign below after you have read and understood all statements.
    I certify that statements made in this volunteer application are true and correct, and have been given voluntarily. I understand that this information may be disclosed to any party with legal and proper interest, and I release the Ponca City Library from any liability for supplying such information.
43. I understand that the Ponca City library reserves the right to screen volunteers and limit the number of volunteers it accepts. I understand that the Library cannon accept any volunteers who would jeopardize any aspect of library services, safety of staff, or patrons.
45. I understand that if I am unable to show up for a scheduled time for any reason, I am to notify my library supervisor as soon as possible. Failure to show up or to notify my supervisor may cause my volunteer opportunity to be terminated.
47. I understand that I will not be paid for my services as a volunteer and I am giving my time freely to the Library.
49. I will not abuse any information or materials I may use or obtain while volunteering.
51. By signing this application you are giving the Ponca City Library permission to perform a background check.
53. Applicant's Signature:
54. Date:
56. Parent or Guardian's Signature:
57. Date:
Leave This Blank:


59. 1. Receive an email copy of this form.
60. Email address

    This field is not part of the form submission.

61. Submit Submit and Print

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