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2. Niceville Public Library Adult Volunteer Application
   Please note: The library does not participate in court-mandated community service programs
4. First Name*
5. Middle Name
6. Last Name*
7. Maiden Name
9. Date of Birth
   Date of Birth
11. Street Address
13. City, State, Zip
15. Home Phone
16. Other Phone Number
18. Email Address
22. Monday

    1. 12 pm - 1 pm
    2. 1 pm - 2 pm
    3. 2 pm - 3 pm
    4. 3 pm - 4 pm
    5. 4 pm - 5 pm
    6. 5 pm - 6 pm
23. Tuesday

    1. 9 am - 10 am
    2. 10 am - 11 am
    3. 11 am - 12 pm
    4. 12 pm - 1 pm
    5. 1 pm - 2 pm
    6. 2 pm - 3 pm
    7. 3 pm - 4 pm
    8. 4 pm - 5 pm
    9. 5 pm - 6 pm
    10. 6 pm - 7 pm
24. Wednesday

    1. 9 am - 10 am
    2. 10 am - 11 am
    3. 11 am - 12 pm
    4. 12 pm - 1 pm
    5. 1 pm - 2 pm
    6. 2 pm - 3 pm
    7. 3 pm - 4 pm
    8. 4 pm - 5 pm
    9. 5 pm - 6 pm
25. Thursday

    1. 9 am - 10 am
    2. 10 am - 11 am
    3. 11 am - 12 pm
    4. 12 pm - 1 pm
    5. 1 pm - 2 pm
    6. 2 pm - 3 pm
    7. 3 pm - 4 pm
    8. 4 pm - 5 pm
    9. 5 pm - 6 pm
    10. 6 pm - 7 pm
27. Friday

    1. 9 am - 10 am
    2. 10 am - 11 am
    3. 11 am - 12 pm
    4. 12 pm - 1 pm
    5. 1 pm - 2 pm
    6. 2 pm - 3 pm
    7. 3 pm - 4 pm
    8. 4 pm - 5 pm
    9. 5 pm - 6 pm
28. Saturday

    1. 10 am - 11 am
    2. 11 am - 12 pm
    3. 12 pm - 1 pm
    4. 1 pm - 2 pm
    5. 2 pm - 3 pm
29. Would you be willing to volunteer "on call" if needed?

    1. Yes
    2. No
33. Interests

    1. Circulation
    2. Friends' Activities
    3. Library Programs
    4. Reference
    5. Youth Services
    6. Other
34. Other Interest
36. Previous Volunteer / Work Experience
38. Special Skills or Qualifications
    Summarize any special skills or qualifications that you have acquired from previous employment, volunteer work, or other activities, including hobbies or sports.
42. Emergency Contact
44. Address
46. City, State, Zip
48. Home Phone
49. Other Phone Number
53. Patron Record Confidentiality

    Some library volunteer opportunities may give you access to patron or circulation records. These records are confidential and protected by Florida Statute 257.261. Do you agree to protect the confidentiality of any records to which you may have access?
    (Answering “NO” will not preclude a volunteer opportunity with the library.)

    1. Yes
    2. No
55. Background Check

    The City of Niceville requires a background check on all adult applicants prior to volunteering. Background checks are conducted to protect the public and the staff. There will be a fee for the background check.
    
    Have you ever been convicted of any offense(s) other than minor traffic violations?

    1. Yes
    2. No
57. If “YES,” please explain.
61. Electronic Signature Agreement

    1. I Agree

    By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.
63. Agreement and Signature
    By submitting this application, I affirm that the facts set forth in it are true and complete.
64. Date
    Date
Leave This Blank:


66. 1. Receive an email copy of this form.
67. Email address

    This field is not part of the form submission.

68. Submit

* indicates a required field