City of Burnsville Volunteer Application

Thank you for your interest in volunteering for the City of Burnsville. Your application will be used to verify eligibility for a volunteer position with the City. It is our policy to provide equal employment opportunities to all. Individuals are evaluated and selected solely on the basis of their qualifications.

Please furnish complete and accurate information so that we can properly evaluate your application. Be aware that the use of false or misleading information or the omission of important facts may be grounds for immediate dismissal. Also note that information you provide herein may be subject to later verification and/or testing. Once you complete the form, click the submit button at the bottom.

Please note that the CIty of Burnsville does not share information gathered through its sites with third parties for promotional purposes. However, any information you provide to the City is subject to the Minnesota Data Practices Act. This law classifies certain information as available to the public upon request.

Personal Information

First name:

Last name:

Middle name:

Street 1:

Street 2:

City:

State:

* Zip: *

Primary phone:

* OK to call me here

Secondary phone:

OK to call me here

Email address:

Age Range:

Briefly explain your interest in volunteering for the City.

Department or Agency Interest

Education and Training

Highest level of education:

School:

High School:

List areas of interest, special skills, hobbies and/or educational background, and what you hope to gain by volunteering.

Community, Volunteer or Work Experience

1

2

Employer name:

Street 1:

Street 2:

City:

State:

Zip:

Primary phone:

OK to call here

Primary phone:

OK to call here

Email address:

3

Employer name:

Street 1:

Street 2:

City:

State:

Zip:

Primary phone:

OK to call here

Email address:

References

Please provide the name, email, and telephone number of three references who are not related to you.

1

2

First name:

Last name:

Street 1:

Street 2:

City:

State:

Zip:

Primary phone:

OK to call here

Primary phone:

OK to call here

Email address:

Relationship:

3

First name:

Last name:

Street 1:

Street 2:

City:

State:

Zip:

Primary phone:

OK to call here

Email address:

Relationship:

Emergency Contacts

1

2

First name:

Last name:

Street 1:

Street 2:

City:

State:

Primary phone:

Secondary phone:

Relationship:

Conviction Information

This question must be answered before your application will be considered complete. You do not have to answer "Yes" to this question if the conviction or records thereof have been annulled, sealed, set aside, or purged, or if you have been pardoned pursuant to law.
If the answer to this question is "Yes", please provide full particulars in the below box. This information will not be used to bar you from volunteering but may be used to direct your interest to areas less related to the area of your conviction.

During the past 5 years have you served a sentence in a jail or prison or been convicted of a misdemeanor or felony for which a jail sentence could have been imposed?

Conviction Information:

Self Certification

1. I hereby certify that all statements herein are true and complete and authorize investigation of all information contained in this application. I understand that my present employer will not be contacted until I have become one of the finalists for the position for which I am applying.

2. Organizations and persons named herein are authorized to give information regarding me and they are hereby released from all liability for issuing such information.

3. I understand that misrepresentation or omission of facts called for herein will be sufficient cause for cancellation of consideration for volunteerism or dismissal if I have been accepted as a volunteer.

4. I understand that I will need to complete a background check form. I understand that I will need a parent guardian permission form if I am under the age of 18.

I Agree