Your Name:

Today's Date:

Complete Street Address:

City:

State:

ZIP Code:

Home Telephone:

Work Telephone:

May we contact you at work?
Yes | No

Your E-Mail Address:

Special Skills, Abilities and Interests:

Work Experience (Paid and Volunteer):

Preferred Areas of Work:
(You may check more than one)

Where do you want to volunteer?
(Your application will be submitted to the volunteer coordinator at the location you select.)

Which days and hours are you available?

Have you been convicted of a felony or a misdemeanor other than a minor traffic violation?
(Conviction of a crime is not necessarily a bar to volunteering; all circumstances will be considered.)
Yes | No

If you have been convicted, please explain:

References

First Reference:
(Please provide name, address and telephone.)

Second Reference:
(Please provide name, address and telephone.)

By submitting this form, I certify that any and all statements made on this application are true, complete and correct to the best of my knowledge. I authorize Baltimore County Public Library to contact the listed references and I give those references consent to respond to questions pertaining to information contained in this application:

The Baltimore County Public Library is an equal opportunity employer / affirmative action employer. If you need assistance with any aspect of the application process, please call the Human Resources Office at 410-887-6177 (TTY/TICAL: 410-821-5705).