Volunteer Application

Form
Volunteer Application

Oak Ridge Animal Shelter
To qualify for volunteering, you must:
• Be 18 years or older and have a valid driver’s license or identification card stating your current address. If you are under 18, then a parent/guardian must fill out an application also and be always present with you.
• Pass a local criminal background check
Name*

First NameMiddle NameLast NameSuffix
Preferred name (if different from legal name)

First NameLast Name
Today's Date*

MonthDayYear
Date
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Mailing Address (If different than the above address)

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*
Please enter a valid phone number.
Email*
example@example.com
Date of Birth*

MonthDayYear
Date
ID/Driver's License Number*
State associated with your ID*
Spouse/Partner name

First NameLast Name
YesNo
If so, please list their name and department below*
N/A if you answered no
YesNo
If so, please list your positions. *
N/A if you answered no
Have you ever been convicted of violating any law including minor traffic offenses? If so, please describe below (include when, where, what charge, your age at time of conviction). *
Why do you want to volunteer for The Oak Ridge Animal Shelter? Please indicate below if this is required community service.*
I have pets of my own, I love animals!I have never had a pet, so I would love to learn how to care for them.I have owned pets previously, but my current lifestyle does not allow me to. I want to volunteer because I love being around animals.I have previous animal volunteer experienceI have previous professional animal experience (working at an animal care facility)
If you checked previous volunteer or professional experience, then please list where and when you worked/volunteered.
The following statements are true to the best of my knowledge: *

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Date*

MonthDayYear
Date

Emergency Medical Information
Emergency Contact name *

First NameLast Name Relationship
Emergency Contact Phone number*
Please enter a valid phone number.
Emergency Medical Information
YesNo
If so, what medications?*
Type N/A if you answered no
Additional comments/Major medical concerns you think we should know.
Signature

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Date

MonthDayYear
Date

Release of Liability
I,First Name* Last Name*, for valuable and sufficient employment by the City of Oak Ridge, Tennessee, for myself, my heirs, executors, and administrators, hereby remise, release, and forever discharge the City of Oak Ridge, Tennessee, of and from any and all manner of action or actions, cause or causes of actions, suits, liability for
personal injury or death or damages incidental thereto, including, but not limited to, medical bills, life earnings, pain and suffering, claims and demands whatsoever, in law or equity, which against the City of Oak Ridge or its employees, agents or representatives I have had, now have, or which I may have on account of my taking and participating in volunteer employment given by the City of Oak Ridge, and anything incidental thereto, or which my heirs, executors, or administrators hereafter can, shall or may have, for or by reason of any manner, cause, or thing whatsoever, from this date forward.
Furthermore, I realize the potential danger and hazard in the aforementioned volunteer employment, and anything incidental thereto, and therefore I hereby assume all risks and dangers to both my health and life, regardless of the nature or method of creation of such risks and dangers, and hereby bind my heirs, executors, administrators, and assigns to said assumption.
It is my intent in agreeing to the above provisions that neither the City of Oak Ridge nor any of its employees, agents, or representatives be held liable or be required to expend any money for any reason whatsoever in regard to my participation, involvement, or connection with the volunteer employment or anything incidental thereto.
Signature*

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Date*

MonthDayYear
Date

RELEASE OF INFORMATION AUTHORIZATION

Volunteers in Police Services City of Oak Ridge, Tennessee

The shelter is operated by the Oak Ridge Police Department.

This part is required for your background check.

I,First Name* Last Name*, the undersigned do hereby authorize my former schools,
colleges, universities, my former employers or any other party to release any and all transcripts or my grades, records of employment, documents, reports, evaluations, and other information concerning me, whether personal or otherwise, to the City of Oak Ridge and its representatives. I hereby authorize all local, state, and national law enforcement agencies to release any and all information pertaining to my arrest history and status to the City of Oak Ridge. This information is to be provided in connection with my application for volunteering with the police department. Further, I do hereby agree to waive any privileges that I may have said information furnished pursuant to this authorization. Reproduced copies of the authorization are a valid as the original copy.
Date* Street Address* Address Line 2* City* State* Zip* Social Security number* Date of Birth* ID #, State issued*
Signature

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Form

Volunteer Application

Emergency Medical Information

Release of Liability