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2. Name*
3. Last Name*
5. Address*
6. City*
7. Zip Code*
9. Telephone Number 1*
10. Telephone Number 2
11. Email Address*
12. Shirt Size
14. Note

    You may be disqualified in certain positions with the City of Beavercreek if the results of the criminal background check reveal a particular criminal history. 

16. Position of Interest

    Please choose from the following which position you are interested in. 

18. Senior Center

    1. Desk Receptionist
    2. Van Driver
    3. Van Escort
    4. Scheduler
    5. Kitchen/Dining Room
    6. Fitness Center
    7. Special Events
    8. Library
    9. Decorating
19. Golf Club

    1. Ranger/Starter
    2. Groundskeeper
    3. Senior Advisory Board
20. Parks and Recreation

    1. Special Events
    2. Summer Programs
21. Other

    Please specify.

23. Shift Availability *

    Please indicate the shifts and days you are available to volunteer.

    1. Monday AM
    2. Monday PM
    3. Tuesday AM
    4. Tuesday PM

    1. Wednesday AM
    2. Wednesday PM
    3. Thursday AM
    4. Thursday PM

    1. Friday AM
    2. Friday PM
    3. Saturday AM

    1. Saturday PM
    2. Sunday AM
    3. Sunday PM
25. Van Drivers Only:
26. Do you have a valid Ohio driver's license?

    1. Yes
    2. No
28. Driver's License Number
29. State
30. Expiration
32. Have you ever had your license suspended?

    1. Yes
    2. No
33. Do you have any driving restrictions?

    1. Yes
    2. No
34. 4) Are you currently taking any medication that could impair your ability to drive a vehicle?

    1. Yes
    2. No
37. If you answered yes to any of the questions above, please explain:
39. Van Drivers Signature

    By typing my full name and date below, I understand that prior to starting a volunteer position as a van driver, I will be drug and alcohol tested and that accepting this position requires me to follow the city’s volunteer drug-free workplace policy.

41. Signature
42. Date
44. All Volunteer Applicants

    By typing my full name and date below, I affirm that all information provided in this application is true and accurate.  I authorize the City of Beavercreek to complete an application verification to assist in determining my suitability as a volunteer.  I understand the background check will include, but not limited to, a criminal history and driving record.  I also acknowledge that false statements are grounds for not being accepted.

    I further understand that volunteers are not covered by workers' compensation, and I will not hold the City of Beavercreek liable for injuries while volunteering for the City.

46. Signature*
47. Date*
49. Thank you!

    Thank you for your interest in volunteering with the City of Beavercreek! A member of our team will be in touch with you shortly. 

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52. 1. Receive an email copy of this form.
53. Email address

    This field is not part of the form submission.

54. Submit

* indicates a required field