HomeMy WebLinkAboutVolunteer ApplicationOffice of the Prosecuting Attorney
Volunteer Application
Name:_____________________________________________ Today’s Date: ___________________
Birth Date: _________________ Email : _________________________________________________
Home Address:______________________________________________________________________
Home Phone:____________________________Cell Phone: ________________________________
Emergency Contact:_______________________________ Relationship: ____________________
Address:______________________________________________Phone:______________________
Medical Insurance Company: _________________________________________________________
Educational Background:
High School Attended: _______________________________________________________________
Date of Graduation: ___________ or Highest Grade Completed:________________
University Attended/Attending:_______________________________________________________
Major:______________________________________Date of Graduation:_____________
Employment History: Please list employment, starting with most recent, during last 3 yrs.
Company:________________________________________ Dates Employed: __________________
Position: ______________________________ Supervisor: ___________________________
Company: ________________________________________ Dates Employed:__________________
Position:______________________________Supervisor:___________________________
Company:_______________________________________Dates Employed:___________________
Position: _______________________________Supervisor: __________________________
Do you require any reasonable accommodations to perform job duties?: ________________
______________________________________________________________________________________
What is you major reason for wanting to volunteer?:____________________________________
______________________________________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________
Update 01/2021
Update 01/2021
To help provide you with the best possible placement as a volunteer please indicate
below which of the following areas you have an interest.
Typing Clerical Public Speaking Crisis Intervention
Counseling Elderly Domestic Violence Victim Assistance
Art/Graphics Publicity Legal Research Court Monitoring
Children Computer Legislature Education
Community Resource Development Other:_________________________________
What days and times can you volunteer?: ______________________________________________
Have you ever worked as a paid staff or volunteer in any part of the justice system?______
If yes, Please describe briefly:_________________________________________________________
We are required to complete background check on all applicants. Have you ever been
arrested or convicted of any crime?:________ If yes, please explain:____________________
______________________________________________________________________________________
Describe any community activities you participate in: __________________________________
______________________________________________________________________________________
Please list three references (a minimum of 2 references should not be related to you):
Name Address Phone
1.
2.
3.
Volunteer Signature__________________________________________ Date___________________
FOR OFFICE USE ONLY
Interview Date: ________________ Date Referred for Clearance:____________ Cleared:_____
Assigned to:_________________________________________________________________________
Comments:__________________________________________________________________________
Starting Date:________________________Ending Date:_________________________
Notes: _______________________________________________________________________________
Update 01/2021
AUTHORITY TO RELEASE INFORMATION
To Whom It May Concern:
In connection with the background investigation being conducted by theCounty of Hawaii, I hereby authorize any authorized representative of County of Hawaii,bearing this release, or copy thereof, within one year of its date, to obtain any informationin your files pertaining to my grievance records, employment, military, credit or
educational records, criminal and traffic records, including, but not limited to, academic,achievement, attendance, athletic, personal history and disciplinary records; medicalrecords, and credit records. I hereby direct you to release such information upon requestof the bearer. This release is executed with full knowledge and understanding that theinformation will be used in connection with the consideration of my employment by the
County of Hawaii and will be disseminated to those individuals or agencies directlyinvolved in this determination or to fulfill other obligations imposed by law, regulation orexecutive order. I hereby release you, as the custodian of such records, and any lawenforcement, government agency, school, college, university, or other educationalinstitution, hospital, or other repository of medical records, credit bureau, consumer
reporting agency, or retail business establishment including its officers, employees, orrelated personnel, both individually and collectively, from any and all liability fordamages of whatever kind, which may at time result to me, my heirs, family or associatesbecause of compliance with this authorization and request to release information, or anyattempt to comply with it. Should there be any questions as to the validity of this release,
you may contact me as indicated below.
Full Name:___________________________________________
(Signature)
Full Name:___________________________________________(Type or Print)
Any Former Name(s):___________________________________________
Date:___________________________________
Current Address:___________________________________________
Telephone Number:___________________________________
Social Security Number:___________________________________