• The personal data collected on this form is classified as a public record and may be made available to the public as provided by Utah Code § 63G.2.201

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    To proceed with completing the Duchesne County Volunteer Application Form, please select the ‘Next’ button to continue.

  • By continuing with the following form you agree that the following statements are true and correct :

    "Volunteer" means any person who donates service without pay or other compensation. Volunteers are not considered employees under the County Personnel Policies.

    "Volunteer" does not include any person who has been convicted of a criminal offense; and youth who has been adjudged delinquent; or any person or youth who has been diverted from the criminal or juvenile justice system and performs a public service as a condition of the person or youth's sentence, diversion, probation, or parole. Services rendered by a volunteer shall not be the same type of service which the person is otherwise employed to perform for the county. A volunteer may not donate any service to Duchesne County unless the volunteer's services are approved by the County Commission or the department head, and by the Office of Personnel. Volunteers are not covered by other provisions of the County's personnel policies, except they may be entitled to receive workers' compensation medical benefits. Reference: Utah Code 67.20.2

  • Duchesne County Volunteer Form

  • Format: (000) 000-0000.
  • Format: (000) 000-0000.
  • Volunteer Department:*

  •  By continuing with the Duchesne County Fair Volunteer Form Section, you agree to Perform duties necessary and as assigned to aid in the opperation and preparation of the Duchesne County Fair.

    Duties: Complete duties as assigned to aid in the opperation and preparation of The Duchesne County Fair.

     

    *Please Note: Volunteer positions are not eligable for leave, health or retirement benefits.*

  • Please select the activity you would like to volunteer for:

  • Dedicated Hunter Volunteer hours:

     

    Volunteers in the Dedicated Hunter Volunteer position typically complete the number of volunteer hours listed below each year, with a total by the end of the 3rd year.

    Year: Hours:  Employees (Typically) accure:
    1 6 of volunteer hours during the first year
    2 22 of volunteer hours by the end of the second year
    3 32 of volunteer hours by the end of the third year.

     

     

  • Dedicated Hunter Volunteer (Please indicate the number of years you have volunteered with this department.)
  • Date:*
     . .

  • Please note these are the tasks that need to be completed before submitting your application:

    o    Copy of Driver’s License

    o    Driver’s License Check Form

    o    Emergency Contact Information

    o    Right of Access Waiver (Background Check)

    o    Volunteer Application

    o    Volunteer Service Agreement

     

    To move on to the next secion select the Next button to continue: 

  • Volunteer Application Duchesne County

  • Please be sure to submit a copy of your Driver's license with this form:

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  • Are you a registered sex offender?*
  • Have you ever been convicted of, pleaded "No Contest" or guilty for any offenses other than traffic violations? (A criminal record will not automatically bar you from volunteering)*
  • Have you volunteered at the County before?*
  • Have you ever provided volunteer service to anyone before?*
  • Do you have current employment?*
  • Have you ever been employed by Duchesne County?*
  • Are you POST-retired with Utah Retirement Systems (URS)?*

  • Volunteer Policy 206

  • Vehicle Policy 405

  • Discriminatory Harassment 602

  • Volunteer Service Agreement

    1. I agree to engage in only those activities assigned to me by an authorized representative of Duchesne County.
    2. I understand and agree that in the course of providing volunteer services to Duchesne County, I may obtain knowledge or information which I otherwise would not have obtained. I agree that I shall not discuss or disclose any such information to anyone outside of the Duchesne County department from which I obtained such information.
    3. In the course of providing volunteer services to Duchesne County. I shall abide by instructions and directions given to me by the volunteer organization and person in charge of volunteer
    4. I will not at any time hold myself out or represent to anyone that I am a paid volunteer or employee of Duchesne County.
    5. I understand that I will receive no pay or compensation of any kind for the services I render to Duchesne County, and that my volunteer services may be discontinued and/or terminated by Duchesne County at any time and for any reason.
    6. I understand and agree that I will be fully and completely responsible for unsafe actions, and that Duchesne County will not defend or indemnify me for any of my conduct while acting as a volunteer for Duchesne County.
    7. I will defend, indemnify and hold Duchesne County harmless of and from any and all liability which may be incurred by Duchesne County as a result of any intentional and/or willful misconduct, criminal conduct or grossly negligent conduct provided by me to Duchesne County in connection with my volunteer services.
    8. I consent and agree to provide a photograph of myself and submit to a full and complete background and criminal history check, both prior to and at any time during my volunteer service to Duchesne County.

  • I have read and do completely understand all of the above terms and conditions of my volunteer service to Duchesne County.

  • Volunteer Acknowledgement:

  • I do hereby certify that all of the statements and representations set forth in this application are correct and truthful. I have read the Duchesne County Volunteer Job Description and understand the requirements of this position.

    Unless specified, all volunteer positions run for a 1 year period of time.  We are most interested in volunteers who intend to commit themselves to the programs for an extended period of time.  I hereby certify that I am obligated to give my best effort and maintain high standards of service and honor the confidentiality of clients and information.

  • Date*
     . .

  • Right of Access Provider Waiver

  • Duchesne County

    Request to Obtain a Copy of My Utah Criminal History Record

    I, the undersigned, am requesting a copy of my Utah Criminal History Record. I understand this record is protected by law (Utah Code Ann. §53-10-108) and may only be released to me by this agency if I appear in person with valid photo identification. This agency is not authorized to retain a copy of this record without my expressed permission.

  • Date of Birth
     / /

  • Please inital the box which MOST Applies:

  • I wish to obtain a copy of my Utah Criminal History Record to take with me today. This agency may NOT retain a copy for any puropose.

  • I authorize a release of my Utah Criminal History Record, or any part thereof, by and jto any duly authorized agent of this agency to accompany my employument, volunteer, licensing, permit application, or other expressed purpose approved by me today. Any information discovered may be used to consider my suitability for the purpose of my application.

  • Date:*
     . .

  • Third Party Release Form

  • Format: (000) 000-0000.
  • Date
     . .
  •  
  • Should be Empty: