Volunteer Application

LPVAS Volunteer Application
Name
Name
First
Last
Residential Status
Position Desired
Date, Month, Year
Shifts Available
If yes: name, email address, and phone number of employer
ex: NY Class D
Have you ever been convicted of a felony?
*You will not be denied membership solely because of a conviction record unless the offense is related to the position for which you have applied
School name, years attended, graduated (Y/N), degree
School name, years attended, graduated (Y/N), degree
School name, years attended, graduated (Y/N), degree
School name, years attended, graduated (Y/N), degree
Date (month and year), name and address of employer, salary, position, and reason for leaving
Name, address, phone number
Name, address, phone number
Name, address, phone number
“I certify that the facts contained in this application are true and complete to the best of my knowledge and understand that if employed, falsified statements on this application shall be grounds for dismissal. I authorize investigation of all statements contained herein and the references listed above to give you any and all information concerning my previous employment and any pertinent information they may have, personal or otherwise, and release all parties from all liabilities for any damage that may result from furnishing the same to you. I understand and agree that if hired, my employment is for no definite period and may regardless of date of payment of my wages and salary be terminated at any time without prior notice”