Volunteer Application Form

Please complete this form to apply to become a volunteer for the City of Lawrence.

**Medical Professionals who have signed up to volunteer AND are able to administer the vaccine- Must be licensed in the state of MA and will be required to provide their medical license number, as well as, proof of professional liability insurance.**

Name and Address

First name:

Last name:

Nickname:

Street 1:

Street 2:

City:

State:

* Zip: *

Home phone:

Cell phone:

2nd Language:

Medical Title:

State Licensed:

Are you vaccinated ?:

MEDICAL LICENSE NUMBER: (REQUIRED IF APPLICABLE)

Availability

Vaccination clinics are open Monday through Saturday 8am-4pm. Volunteer opportunities are scheduled in 4-hour time blocks and volunteers are able to select up to two time blocks (8 hours) per day.
***PLEASE NOTE: Available shifts will be offered to volunteers once the City of Lawrence has verified and approved your submitted CORI request with back up documentation.***

Sun

Mon

Tue

Wed

Thu

Fri

Sat

From:

To:

My availability is:

From:

to:

Number of hours available:

hours:

Email Preferences

The City of Lawrence would like to keep volunteers informed of important news, schedule changes, and available volunteer opportunities via email, however, if you prefer, you may also sign up for updates via text message. Please indicate below how you would like to receive information from us.

Background Check Agreement

*** Please go to WWW.CITYOFLAWRENCE.COM/CORI to download a CORI request. Please submit your request and a copy of your valid ID to JOBS@CITYOFLAWRENCE.COM ***

I, hereby authorize The City of Lawrence to investigate my background and qualifications for purposes of evaluating whether I am qualified for the position for which I am applying. I understand that The City of Lawrence will utilize an outside firm or firms to assist it in checking such information, and I specifically authorize such an investigation by information services and outside entities of the company's choice. I also understand that I may withhold my permission and that in such a case, no investigation will be done, and my application for employment will not be processed further.

I Agree