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Application for Volunteer Service

2. Personal Information
4. Name*
5. Email Address*
7. Address*
9. City*
10. State*
11. Zip Code
13. Phone Number*
14. Date of Application
    Date of Application
15. Birth Date*
17. Are you Hispanic or Latino?

    1. Yes
    2. No
18. Are you a Veteran?

    1. Yes
    2. No
19. Race (select one or more)

    1. Hispanic
    2. White
    3. Black/African American
    4. Asian
    5. Middle Eastern or North African
    6. American Indian/Alaska Native
    7. Native Hawaiian/Pacific Islander
    8. Prefer not to respond
21. Group Volunteer*
    -- Select One --YesNo

    Please indicate if you are a member of an organization applying to volunteer as a group.
22. Group Name
26. Emergency Contact
28. Name*
29. Relationship*
31. Address
33. Phone Number*
34. Email Address
38. Beneficiary of FREE supplemental Volunteer Insurance
40. Name*
41. Relationship*
43. Address
44. Phone Number*
48. References
50. Name*
51. Relationship
53. Email
54. Phone Number*
56. Name
57. Relationship
59. Email
60. Phone Number
64. Volunteer Fields
66. Check all that interest you

    1. Administrative Support
    2. Animal Services
    3. Arts & Crafts Instructor
    4. Bingo Caller
    5. Café Worker
    6. Census 2020
    7. Computer Teacher

    1. Community Gardener
    2. Dining Room Aide
    3. Driver/Deliveries
    4. Greeter
    5. Dance & Activities Planner
    6. Library Services
    7. Museum Guide

    1. Receptionist
    2. Sewing/Quilting/Knitting Leader
    3. Senior Programs Representative
    4. Translator (English/Spanish)
    5. Veteran's Service
    6. Youth Mentor
    7. Other
68. If you elect "other," please specify
72. Additional Information
74. What is your education background?

    1. Primary School
    2. GED

    1. Associates
    2. Trade School

    1. Bachelors
    2. Masters

    1. Doctorate
76. Why do you wish to volunteer?*
78. How did you hear about us?

    1. City's website
    2. Flyer
    3. Friend

    1. Newspaper
    2. Radio
    3. Social Media

    1. Subsidized Work
    2. Walk-In

    1. Enlisted
    2. Other
80. What is your T-shirt size?

    1. Small
    2. Medium

    1. Large
    2. X-Large

    1. XX-Large
    2. XXX-Large
82. Will you require any special accommodations as a volunteer?

    1. Yes
    2. No
83. If "yes," please explain
85. Have you been convicted of (or plea bargained to) any violations of law, including felony charges?*

    1. Yes

    1. No
86. Do you have any pending charges or cases open in which a decision has not been made yet?*

    1. Yes

    1. No
88. If yes to either question above, please provide description of the offense, date of charge, date of conviction, pending charges, County, City or State of convictions
90. Please note volunteer placement may be subject to the results of a criminal background check or other screening
94. Availability
96. Check the best schedule for your needs*

    1. Regular, weekly

    1. On-call

    1. One-time opportunity
98. Check your availability for volunteer service*

    1. Monday Morning
    2. Monday Afternoon
    3. Monday Evening
    4. Tuesday Morning
    5. Tuesday Afternoon
    6. Tuesday Evening

    1. Wednesday Morning
    2. Wednesday Afternoon
    3. Wednesday Evening
    4. Thursday Morning
    5. Thursday Afternoon

    1. Thursday Evening
    2. Friday Morning
    3. Friday Afternoon
    4. Friday Evening
    5. Saturday Morning

    1. Saturday Afternoon
    2. Saturday Evening
    3. Sunday Morning
    4. Sunday Afternoon
    5. Sunday Evening
102. Electronic Signature Agreement*

     I certify that the above information is correct and complete to the best of my knowledge, without consequential omission of any kind. I authorize the Volunteer Network to release information requested regarding my service, character, and qualifications. I understand that the Volunteer Network may conduct a criminal background check as part of the screening process if my volunteer service involves either working with children, frail seniors, or concerns sensitive information. I understand that I'm not an employee of the Volunteer Network or the City of Las Cruces and agree to serve without compensation or employee benefits. Specifically, I recognize that I will not be entitled to Worker's Compensation should I become injured during my volunteer service. Specifically, I acknowledge that I will not be entitled to Worker's Compensation should I become injured during my volunteer service. I recognize that volunteer work is not without risks, and I agree to help minimize those risks by exercising reasonable judgment and due care for my safety, which may involve not performing a task that goes beyond the risks I wish to accept. I further agree that if I use my personal automobile to drive to and from my Volunteer Station or during my service, I will keep in effect automobile liability insurance equal to or greater than the minimum required by the state of New Mexico and will ensure that my driver's license is kept current and has not expired. I acknowledge that by completing this application, The Network is not obligated to offer me a volunteer position. I also understand that the Volunteer Network/City of Las Cruces may use my story, photos, and videos of me and my volunteer service in upcoming publicity and marketing materials. I understand the Volunteer Network will use an email service to maintain contact with me regarding future events or service opportunities and that I may opt-out of this service at any time.

     1. I agree.
104. Electronic Signature*
105. Date
     Date
107. Electronic Signature of Parent

     Sign here if volunteer is under 18 years old

     1. I agree.
109. Electronic Signature
110. Date
     Date
Leave This Blank:


112. 1. Receive an email copy of this form.
113. Email address

     This field is not part of the form submission.

114. Submit

* indicates a required field