Please read the instructions carefully and complete the application in its entirety. Incomplete applications will not be accepted or considered for volunteer opportunities.

All volunteers must be at least 17 years old, unless volunteer is completing Court-Ordered Community Service.

Name (Last, First)*

Address*

City*

State*

Select a StateAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMassachusettsMarylandMichiganMinnesotaMississippiMissouriMontanaNorth CarolinaNorth DakotaNebraskaNevada New Hampshire New JerseyNew MexicoNew YorkOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVirginiaVermontWashingtonWest VirginiaWisconsinWyomingWashington D.C.

Zip*

Phone Number*

Other Phone

E-Mail Address

Driver's License Number*

State Issued*

Select a StateAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMassachusettsMarylandMichiganMinnesotaMississippiMissouriMontanaNorth CarolinaNorth DakotaNebraskaNevada New Hampshire New JerseyNew MexicoNew YorkOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVirginiaVermontWashingtonWest VirginiaWisconsinWyomingWashington D.C.

Are you volunteering for:*

A special event? Community Outreach

Court Ordered Community Service Teen Volunteer

If you are volunteering due to court ordered Community Service, when must it be completed?*

If you are volunteering due to court ordered Community Service, why are you being required to fulfill Community Service?*

If you are volunteering due to court ordered Community Service, how many hours must you complete?*

Have you had any convictions, probations or deferred adjudications for a felony?*

Yes

No

Have you had any convictions, probations or deferred adjudications for any misdemeanor offenses, other than a minor traffic violation? If you answered yes, please explain.*

What was the class of the misdemeanor(s)? If you were not charged with a misdemeanor, choose not applicable.*

Class A Class B

Class C not applicable

Do you have any pending criminal charges for a felony offense?*

Yes

No

Do you have any pending charges for any misdemeanor offenses, other than a minor traffic violation? If you answered yes, please explain. *

If you answered yes to any pending charges, what is the class of the misdemeanor(s)? If you do not have any pending charges for a misdemeanor, choose not applicable.*

Class A Class B

Class C Not Applicable

Emergency Contact Name*

City*

What is your relationship to the emergency contact person? For instance, is he or she your spouse, relative, friend, coworker, etc...*

Emergency Contact Phone Number*

Additional Phone Number

Consent for background check:

I hereby give my permission for the Zula B Wylie Public Library to obtain information relating to my criminal history. The criminal history, as received from the reporting agency, may include arrest and conviction data as well as plea bargains and deferred adjudications. I understand that this information will be used, in part, to determine my eligibility for a volunteer position. I understand that as long as I remain a volunteer, Zula B Wylie Public Library reserves the right to obtain additional criminal history reports as necessary.

Signature*

Signature of Parent/Guardian if applicant is under 18 years of age.