Adult Volunteer Application
Personal Information
First name:
*
Last name:
*
Street 1:
*
Street 2:
Street 3:
City:
*
State:
Choose
AR
*
Zip:
*
Home phone:
Cell phone:
Other phone:
Demographic Information
The following is not a requirement for volunteer service at Bentonville Public Library, but please feel free to provide it, if you wish.
Date of birth:
Month
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Day
1
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Year
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1933
1932
1931
1930
1929
1928
1927
1926
1925
1924
1923
1922
1921
1920
1919
1918
1917
(year optional)
Age:
Gender:
Choose
Female
Male
Emergency Contact Information
First name:
*
Last name:
*
Street 1:
*
Street 2:
Street 3:
City:
*
State:
Choose
AR
*
Zip:
*
Home phone:
Cell phone:
Other phone:
Email address:
Relationship:
Choose
Co-worker
Daughter
Father
Friend
Mother
Neighbor
Son
Spouse
Supervisor
*
Email Preferences
The Bentonville Public Library utilizes a program called VicNet to record volunteer hours, inform volunteers of news, schedule changes and volunteer opportunities. However, we will not send you any e-mail you prefer not to receive. Please enter an active e-mail address, and create a unique password for access to your volunteer record. If you do not have an e-mail, leave these fields blank.
Email address:
Please enter a password that:
Is between 6 and 30 characters long
Password:
Confirm password:
What kinds of email would you like to receive?
Electronic newsletters
Recruitment appeals
Checklist reminders
Schedule
Please indicate your preferred schedule.
Mon
Tue
Wed
Thu
Fri
Sat
From:
9:00am
9:30am
10:00am
10:30am
11:00am
11:30am
12:00pm
12:30pm
1:00pm
1:30pm
2:00pm
2:30pm
3:00pm
3:30pm
4:00pm
4:30pm
5:00pm
5:30pm
6:00pm
6:30pm
7:00pm
7:30pm
8:00pm
9:00am
9:30am
10:00am
10:30am
11:00am
11:30am
12:00pm
12:30pm
1:00pm
1:30pm
2:00pm
2:30pm
3:00pm
3:30pm
4:00pm
4:30pm
5:00pm
5:30pm
6:00pm
6:30pm
7:00pm
7:30pm
8:00pm
9:00am
9:30am
10:00am
10:30am
11:00am
11:30am
12:00pm
12:30pm
1:00pm
1:30pm
2:00pm
2:30pm
3:00pm
3:30pm
4:00pm
4:30pm
5:00pm
5:30pm
6:00pm
6:30pm
7:00pm
7:30pm
8:00pm
9:00am
9:30am
10:00am
10:30am
11:00am
11:30am
12:00pm
12:30pm
1:00pm
1:30pm
2:00pm
2:30pm
3:00pm
3:30pm
4:00pm
4:30pm
5:00pm
5:30pm
6:00pm
6:30pm
7:00pm
7:30pm
8:00pm
9:00am
9:30am
10:00am
10:30am
11:00am
11:30am
12:00pm
12:30pm
1:00pm
1:30pm
2:00pm
2:30pm
3:00pm
3:30pm
4:00pm
4:30pm
5:00pm
5:30pm
6:00pm
6:30pm
7:00pm
7:30pm
8:00pm
9:00am
9:30am
10:00am
10:30am
11:00am
11:30am
12:00pm
12:30pm
1:00pm
1:30pm
2:00pm
2:30pm
3:00pm
3:30pm
4:00pm
4:30pm
5:00pm
5:30pm
6:00pm
6:30pm
7:00pm
7:30pm
8:00pm
To:
9:00am
9:30am
10:00am
10:30am
11:00am
11:30am
12:00pm
12:30pm
1:00pm
1:30pm
2:00pm
2:30pm
3:00pm
3:30pm
4:00pm
4:30pm
5:00pm
5:30pm
6:00pm
6:30pm
7:00pm
7:30pm
8:00pm
9:00am
9:30am
10:00am
10:30am
11:00am
11:30am
12:00pm
12:30pm
1:00pm
1:30pm
2:00pm
2:30pm
3:00pm
3:30pm
4:00pm
4:30pm
5:00pm
5:30pm
6:00pm
6:30pm
7:00pm
7:30pm
8:00pm
9:00am
9:30am
10:00am
10:30am
11:00am
11:30am
12:00pm
12:30pm
1:00pm
1:30pm
2:00pm
2:30pm
3:00pm
3:30pm
4:00pm
4:30pm
5:00pm
5:30pm
6:00pm
6:30pm
7:00pm
7:30pm
8:00pm
9:00am
9:30am
10:00am
10:30am
11:00am
11:30am
12:00pm
12:30pm
1:00pm
1:30pm
2:00pm
2:30pm
3:00pm
3:30pm
4:00pm
4:30pm
5:00pm
5:30pm
6:00pm
6:30pm
7:00pm
7:30pm
8:00pm
9:00am
9:30am
10:00am
10:30am
11:00am
11:30am
12:00pm
12:30pm
1:00pm
1:30pm
2:00pm
2:30pm
3:00pm
3:30pm
4:00pm
4:30pm
5:00pm
5:30pm
6:00pm
6:30pm
7:00pm
7:30pm
8:00pm
9:00am
9:30am
10:00am
10:30am
11:00am
11:30am
12:00pm
12:30pm
1:00pm
1:30pm
2:00pm
2:30pm
3:00pm
3:30pm
4:00pm
4:30pm
5:00pm
5:30pm
6:00pm
6:30pm
7:00pm
7:30pm
8:00pm
My availability is:
Choose
Ongoing
Ongoing, except between these dates
Only between these dates
*
From:
Month
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Day
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
Year
2022
2023
2024
2025
2026
2027
2028
2029
2030
2031
2032
to:
Month
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Day
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
Year
2022
2023
2024
2025
2026
2027
2028
2029
2030
2031
2032
I would like to serve up to:
hours:
Choose
Daily
Monthly
One time
Weekly
Community Service
Are you completing required community service time? If yes, please note Bentonville Public Library does not accept court-ordered community service applicants.
Motivation for Volunteer Service
Please explain why you are interested in volunteering with the Bentonville Public Library.
Volunteer Agreement and Liability Waiver
By clicking the “I Agree” check box on this volunteer waiver, I agree to the following:
I understand that I am a “Volunteer” for the Bentonville Public Library. As a volunteer, I understand that I will not be compensated (financially, or in any other manner) for my volunteer time. I further understand that I am not an employee of Bentonville Public Library or the City of Bentonville and am not entitled to any benefits that are provided to employees of the City. I further understand that should I apply for future job openings, BPL or City is under no obligation to hire me.
I understand that BPL or the City reserves the right to conduct a police, background and/or criminal background check on me. I understand that volunteer service and retention is contingent on the result of these inquires.
I understand that my volunteer service may be terminated at any time and for any reason by myself or the library administration, with or without notice. As a library volunteer, I will try and provide a minimum of 2 weeks’ notice to the library staff to end my volunteer service.
As a volunteer, I understand that I am under no obligation to perform duties that I feel may be outside the scope of my physical abilities or which I consider hazardous to my health or wellbeing. BPL and the City are not responsible for any injuries I may sustain while volunteering.
As a library volunteer, I am considered a library advocate and supporter and I agree to perform my volunteer duties in a professional and creditable manner and act in the best interests of the Bentonville Public Library.
I release, waive, discharge, and covenant on behalf of myself and my minor children not to sue the City, their elected and appointed officials, agents, volunteers, and employees (“Releasees”) from all liability to me, or my minor children, for any loss or damage, and any claim or demands on account of personal or property injury or because of my, or my minor children’s death, whether caused by Releasees’ negligence or otherwise, while I, and my minor children, participate in the City of Bentonville Municipal Volunteer Program.
I further agree to defend, indemnify, and hold harmless the City and its officers, employees and agents, from and against any and all claims, suits, actions, liability judgment and expenses that may arise by reason of services I, or my minor children, provide as a volunteer or that are connected in any way therewith. I will pay all costs incident to any claim, including, without limitation, attorney’s fees.
I expressly agree that the foregoing release, waiver, and indemnity agreement is intended to be as broad and inclusive as is permitted by the law of the State of Arkansas and that if any portion is held invalid, it is agreed that the balance shall, notwithstanding, continue in full legal force and effect.
I grant permission for the City to use my, or my minor children’s image, filmed or photographed during volunteer activities, to promote its services and programs.
In case of serious injury, I give my permission for City personnel to seek any medical treatment should it become necessary.
I have read and voluntarily sign this release, waiver of liability, and indemnity agreement, and further agree that no oral representations, statements, or inducement apart from the foregoing written agreement have been made.
I Agree
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