Teen Volunteer Application Form

Teen Volunteer Application

For students age 15 through 12th grade.
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 Teen Volunteer Program, please visit myclearwaterlibrary.com/kids-teens/volunteer or call (727) 562-4970 and ask to speak to the Teen 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 teen 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
Please submit a valid email address in order to receive a copy of your completed application.
Phone Number*
Address*

Street Address

Street Address Line 2

CityState

Zip Code
Parent/Guardian Name*

First NameLast Name
Parent/Guardian Phone*
Alternate Phone
Parent/Guardian Email

Emergency Contact Information
Emergency Contact Person*

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

Affidavit of Good Moral Character

Please download, fill out, and print the following form, then sign it in the presence of a Notary Public to have it notarized. You may upload, email, mail, or hand-deliver the completed, notarized form to the library where you would like to volunteer.
The following locations offer Notary Public services for a small fee. Please call first to ensure the Notary Public is available - theupsstore.com:

Harbor Oaks Plaza, 611 S Ft Harrison Ave, (727) 446-3993
Gulf to Bay Blvd, 2803 Gulf to Bay Blvd, (727) 725-9985
McMullen Booth Rd, 2519 McMullen Booth Rd, (727) 726-3456
Ulmerton Rd, 2655 Ulmerton Rd, (727) 556-0500
Island Way, 140 Island Way, (727) 446-0660
You may upload the completed copy of your Affidavit of Good Moral Character here:

Cancelof

Or mail, email, or drop off the completed copy of your Affidavit of Good Moral Character to the Teen Volunteer Coordinator at your preferred location:

Beach Library Leslie Walbolt leslie.walbolt@myclearwater.com 69 Bay Esplanade Clearwater FL 33767	Countryside Library Cassidy Bonovitch cassidy.bonovitch@myclearwater.com 2642 Sabal Springs Dr Clearwater FL 33761
East Community Library Jaclyn Gaither jaclyn.gaither@myclearwater.com 2465 Drew St Clearwater FL 33765	Main Library Kerry Vash kerry.vash@myclearwater.com 100 N Osceola Ave Clearwater FL 33755
North Greenwood Library Amber Priester amber.priester@myclearwater.com 905 N Martin Luther King Jr Blvd Clearwater FL 33755

Drug/Alcohol Free Workplace Policy Acknowledgement
Please read the statement below and acknowledge it by checking 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.

Background Check
Please read the statement below and acknowledge it by checking 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:

Signatures
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.

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
Parent/Guardian 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 Teen Volunteer Program, please visit myclearwaterlibrary.com/kids-teens/volunteer or call (727) 562-4970 and ask to speak to the Teen 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 teen volunteer waiting list and contacted when an opening becomes available.
Should be Empty:

Teen Volunteer Application

Contact Information

Emergency Contact Information

Affidavit of Good Moral Character

Drug/Alcohol Free Workplace Policy Acknowledgement

Availability

Background Check

Signatures