Okaloosa County BOCC — October 21, 2014 — Park Host Volunteer Application — reading text

Park Host Volunteer Application Full Name SSN Mailing Address Email Date of Birth Phone Number Alt. Phone Number Current/Last Employer Contact Person Phone Number Circle the months you would be available for volunteer work. Jan Feb Mar Apr May Jun Jul Aug Sept Oct Nov Dec Circle the days of the week you would be available for volunteer work. Monday Tuesday Wednesday Thursday Friday Saturday Sunday How many hours per week would you be available for volunteer work? List the Parks where you would like to volunteer. | agree to provide the following volunteer services: Created: List three non-family members who can provide references on your ability to perform this volunteer position. Name Phone Number Name Phone Number Name Phone Number List all of the individuals who will reside full time with you at the campsite. Name Relationship Are you a current employee of Okaloosa County BCC? Ll Yes [JNo Have you ever been convicted of acre? []Yes [No If yes, please provide the following information: the nature of the crime, the date of conviction, where the conviction occurred and the sentence or penalty imposed. Please provide any additional information as to conviction that you feel would assist us in evaluating you for the position applied. Details Have you ever been accused of committing an intentional tort? [J Yes [JNo An intentional tort is a wrongful act committed against the person, reputation or property of another. If yes, please provide the details of the intentional tort, when you were accused and its disposition. Details Created: 1 understand that the above-described volunteer services will be uncompensable. Initials | understand that this agreement may be canceled by either party at any time following notice to the other party. Initials | understand that | am not subject to any provisions of state law relating to public employment or to any laws relating to hours of work, rates of compensation, leave time, employee benefits or unemployment, except as provided under Section 125.9504, Florida Statutes. Initials 1 understand that County ordinance prohibits me from having any animals, other than service animals, in the County’s parks. Initials Created: PLEASE READ CAREFULLY APPLICANT’S CERTIFICATION AND STATEMENT | hereby certify that all statements made herein and attached hereto are correct to the best of my knowledge, and understand that any false statement, misrepresentation, or omission of facts, may disqualify me for consideration or later removal from the Park Host volunteer program. Permission is hereby granted to Okaloosa County to investigate my personal history, conduct a criminal background check and solicit statements from any person or organization with which | have ever been associated. In consideration of the receipt of this application by Okaloosa County, | hereby release Okaloosa County and all persons or organizations from any liability arising from such statements, their solicitation or use. | understand that enrollment into the Park Host volunteer program is contingent upon the accuracy of the information contained herein, and that if | am enrolled in the program, the information given in this application will be used as part of my official record. | have read in full and understand the above statements and conditions. Applicant's Signature Date Created: