Adult Volunteer Application Form

Adult Volunteer Application
Under Florida law, certain information provided to municipalities are public records and may be subject to a public records request.

Questions? If you have questions about the Clearwater Public Library System's Adult Volunteer Program, please visit myclearwaterlibrary.com/how-do-i/get-involved/adult-volunteers or call (727) 562-4970 and ask to speak to the Adult Volunteer Coordinator at your preferred library.

If there are current openings for new volunteers, you will be contacted by the library location to which you applied.

If there are no current openings for new volunteers, you will be put on the library location's adult volunteer waiting list and contacted when an opening becomes available.
Contact Information
Submission Date

MonthDayYear
Name (Last, First)*

LastFirst
Date of Birth*

MonthDayYear
E-mail
You must submit a valid email address in order to receive a copy of the completed application.
Phone Number*
Address*

Street Address

Street Address Line 2

CityState

Zip Code
Emergency Contact Information
Emergency Contact Person*

FirstLast
Relationship*
Emergency Contact Phone Number*
Alternate Emergency Contact Phone Number

Drug/Alcohol-Free Workplace Policy Acknowledgement
Please read the statement and policy below and acknowledge by clicking the bubble:*

I have read and understood the city of Clearwater's Drug/Alcohol-Free Workplace Policy (available for download below) and agree to abide by its terms while volunteering for the Clearwater Public Library System.

Patron's Right to Confidentiality Acknowledgement
Please read the statement and policy below and acknowledge by clicking the bubble:*

I have read the Florida Statute on Confidentiality of Patron Records in its entirety. I understand the statute and the Clearwater Public Library System’s policy pertaining to confidentiality of patron records. I agree to keep all patron information confidential, including their name, and agree to abide by the statute while volunteering for the Clearwater Public Library System.
Florida Statute on the Confidentiality of Patron Records

Patron’s Right to Privacy

The Clearwater Public Library System recognizes the need to protect a patron’s right to privacy about the questions they ask and the materials they borrow and read.

In order to guarantee the privacy of each individual, Florida law mandates confidentiality of patron registration and borrowing records, and Clearwater Public Library System policies and procedures fulfill that intent.

Florida Law

Library patron registration and borrowing records are confidential under Florida State Statutes, Chapter 257.261.

Patron’s Personal Borrowing Record

Library staff and volunteers cannot give any information about a patron’s registration and circulation records to anyone other than the patron, with the following exceptions:
- In the case of overdue materials, parents or guardians of minor children under the age of sixteen, may be given a list of the outstanding materials solely for the purpose of reclaiming those materials;
- In the case of overdue materials, information may be given to a collection agency solely for the purpose of reclaiming missing materials.
Library staff and volunteers cannot allow a family member or friend to pick up an item on hold or otherwise access patron information without prior authorization from the card holder.

Authorization may be provided by giving the library card to the designated proxy or by providing in person, with valid identification, verbal authorization to a library staff member, who will enter a permanent note in the patron's record.

Background Check Acknowledgement
Please read the statement below and acknowledge by clicking the bubble:*

I understand that applying to volunteer and volunteering for the Clearwater Public Library System may require or include a criminal background check, driver license check, or the provision of other identification or certifications. Failure to submit or falsification of my answers will result in immediate dismissal as a volunteer for the Clearwater Public Library System.
Have you ever been convicted of any offense against the law or are now under any current charge of any offense against the law?*

YesNo
If the answer to the previous question is "Yes," please give the date(s) and details of the offense(s) here:

Signature
I understand that filling out, signing, and submitting this application does not guarantee me a volunteer assignment with the Clearwater Public Library System. I understand that I may need to complete additional steps for my assignment, including training. I understand that if there are no positions available when I sumbit my application, I will be put on a waiting list. Positions will be filled by location in order of application.

By signing this form, I attest to the accuracy of the information I am submitting to the best of my knowledge.

By signing this form, I grant the city of Clearwater permission to make still pictures, videos, and sound recordings, separately or in combination, of me, and I also give the city of Clearwater permission to use the finished still pictures, videos, and/or sound recordings for all city of Clearwater-related puposes.

Further, I relinquish and give to the city of Clearwater all rights, title, and interest in the finished still pictures, videotapes, and/or sound recordings, duplicates, and prints for all city of Clearwater-related purposes.
Signature*

Clear
Date*

MonthDayYear
Under Florida law, certain information provided to municipalities are public records and may be subject to a public records request.

Questions? If you have questions about the Clearwater Public Library System's Adult Volunteer Program, please visit myclearwaterlibrary.com/how-do-i/get-involved/adult-volunteers or call (727) 562-4970 and ask to speak to the Adult Volunteer Coordinator at your preferred library.

If there are current openings for new volunteers, you will be contacted by the library location to which you applied.

If there are no current openings for new volunteers, you will be put on the library location's adult volunteer waiting list and contacted when an opening becomes available.
Should be Empty:

Adult Volunteer Application

Contact Information

Emergency Contact Information

Availability and Interests

Drug/Alcohol-Free Workplace Policy Acknowledgement

Patron's Right to Confidentiality Acknowledgement

Background Check Acknowledgement

Signature