MORGAN COUNTY VOLUNTEER APPLICATION

MORGAN COUNTY VOLUNTEER APPLICATION
Department or Board*
Date*

MonthDayYear
Date
Program Supervisor*
Volunteer Duties*
Name*

First NameLast Name
Address*

Address

Street Address Line 2

CityState

Zip
Telephone #*
Date of birth*

MonthDayYear
Date
Email*
example@example.com
SS#
Drivers License #
State Issued
Do you agree to conform to the regulations and policies of Morgan County?*

YesNo
Provide a brief statement of why you would want to volunteer with Morgan County:*
Qualifications:

Minimum age: 18 years old, eligible to work in the United States, no felonies.
Can you perform the volunteer duties of this volunteer position without special accommodation? (Answering No does not automatically disqualify you for a volunteer status)*

YesNo
EMERGENCY CONTACT INFORMATION:
Name*

First NameLast Name
Phone #*
Relationship to you*
TERMS & ACKNOWLEDGEMENT
If I am accepted as a Morgan County volunteer, I agree to perform the Volunteer Duties as specified on my selected Volunteer Duties description, to the best of my ability and in a professional manner. If problems arise, I will notify my Program Supervisor as soon as possible before my assigned shift. I acknowledge that my service as a volunteer is at-will, meaning I have no right to continuing service as a volunteer. My service as a volunteer may be terminated at any time, for any reason, or no reason.
CONFIDENTIALITY:
I agree to maintain the same strict confidentiality in the performance of my Volunteer Duties that is expected of any paid staff.
RELEASE:
While performing Volunteer Duties as a volunteer (unsalaried worker), I shall be deemed an employee of Morgan County only to the extent provided for under the Utah Volunteer Government Workers Act, U.C.A. Title 67, Chapter 20, which includes the following: A. Medical benefits under Worker’s Compensation for any injury sustained while engaged in performance of service; B. Properly licensed operation of county vehicles or equipment (if applicable); and C. Liability protection normally afforded paid employees. If I, as a Morgan County volunteer, sustain injury, cause injury to another person, or damage county property or the property of another person while performing Volunteer Duties, I shall immediately report such injury or damage to my Program Supervisor and cooperate fully with Morgan County. I hereby release Morgan County and its agents and employees from any liability or obligation arising from, or in connection with, my Volunteer Duties with Morgan County. I have read and understand the above conditions. I certify that all information made in this application is true. I understand that I am required to abide by all rules and regulations, policies, and procedures of Morgan County. I Hereby Certify that all the information on this application is true and complete.
Date*

MonthDayYear
Date
Applicant Signature*

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referral Source*

First NameLast Name
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MORGAN COUNTY VOLUNTEER APPLICATION

Qualifications:

EMERGENCY CONTACT INFORMATION:

TERMS & ACKNOWLEDGEMENT

CONFIDENTIALITY:

RELEASE: