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Volunteer Registration Record

2. 

4. Volunteer Registration Record - Ongoing Volunteers
   Daggett County Department of Human Resources

   Daggett County Department of Human Resources

6. Applicant Information

8. Volunteer Position(s) Desired*

10. Volunteer Name (Last, First, Middle Name)*

11. Birth Date*
    Birth Date

13. Home Address*

15. City*

16. State*

17. Zip Code*

19. Phone Number*

20. Email Address*

22. Do you have a Valid Utah Driver's License?*

    1. Yes
    2. No

24. Emergency Contact Name*

25. Emergency Contact Phone Number*

27. Have you been identified as a perpetrator of child abuse or neglect?*

    1. Yes
    2. No

29. Have you been convicted of a felony?*

    1. Yes
    2. No

31. Do you have a felony charge pending?*

    1. Yes
    2. No

33. Have you been convicted of a misdeamor?*

    1. Yes
    2. No

35. Have you received any moving traffic violations in the last 2 years?*

    1. Yes
    2. No

37. Education

39. If Yes, Explain:

41. Highest grade completed:*

42. High School Diploma or GED?*

    1. Yes
    2. No

44. Employment/Volunteer History

46. Paid Position: *

    Name, address and phone of current or most recent employer.

48. If currently employed, may we contact you at work?*

    1. Yes
    2. No

50. Does Daggett County have your permission to contact your employer or volunteer organization?*

    1. Yes
    2. No

52. My skills and interests include:

54. Describe Volunteer Experiences:

56. References

58. Reference 1*

59. Relationship*

60. Address

61. Phone Number*

63. Reference 2*

64. Relationship*

65. Address

66. Phone Number*

68. Reference 3*

69. Relationship*

70. Address

71. Phone Number*

73. Daggett County has my permission to contact references, and to do a criminal record check, a Children's Protective Services and a driving record check.*

    1. I give my permission for this request.

75. By submitting electronically, I am confirming I am not a minor and I am electronically signing with my consent and authority.*

    1. I am not a minor.
    2. I am the minor's parent/guardian and I give this minor my consent to volunteer for this position.

76. Date Submitting*
    Date Submitting

78. If this applicant is a Minor, parent or guardian name:

Leave This Blank:


80. 1. Receive an email copy of this form.
81. Email address

    This field is not part of the form submission.

82. Submit Submit and Print

* indicates a required field