Volunteer Application - Polk County Board of County Commissioners

Please complete this application form when applying ONLY for volunteer assignments with divisions and programs of the Polk County Board of County Commissioners. If you are uncertain if this pertains to your assignment of interest, please contact us at volunteerpolk@polk-county.net or 863-534-5580. After submitting your application, you will receive an automatic email confirming receipt of your application. Processing time can vary depending on staffing and demand. If you have not heard from someone regarding your placement after two weeks, please make inquiry!

Personal Information

Completing this section in full assists in the processing of your application. Aliases include premarital names or versions of your name that have been used (i.e Johnson, Smith, and Johnson-Smith or Smith-Johnson).

First name:

Last name:

Middle name:

Title:

Nickname:

Age Category:

Kind:

Individual Group

Group name:

Members:

Street 1:

Street 2:

City:

State:

* Zip: *

Home phone:

Work phone:

Cell phone:

Fax phone:

Other phone:

Email address:

Date of birth:

Aliases:

FL Drivers License or ID:

What kinds of email would you like to receive?

Opportunity Announcements

Opportunity Announcement emails are sent when a new opportunity is available and is either a one day project/event or is in immediate need of help.

Volunteer Recognition Event

Volunteer Recognition Event emails are sent in regards to ONLY the annual recognition event hosted by Volunteer Polk.

Program Updates

Program Update emails are sent when new features are available to you for access to your volunteer information, when new policies apply to the way volunteerism works in the county, or other important news about Volunteer Polk.

Emergency Contact Information

In case of injury or distress, who should we or your volunteer supervisor contact?

First name:

Last name:

Middle name:

Nickname:

Home phone:

Work phone:

Cell phone:

Email address:

Relationship:

Demographic Information

The following information is optional. It is used to understand the demographic make-up of our volunteers and potential qualification of occasional grant funding.

Gender:

Education:

Ethnicity:

Availability and Location

Indicate which days and times you are available as well as your location preferences.

Skills and Experience

Your skills will be used to match you with alternative placements if the assignment(s) you choose are full.

Assignment Preferences

Assignments not currently accepting new volunteers have the word "full" after the title. If you select a "full" assignment and have not yet spoken with the site of interest directly, you will be placed on a wait list.

How did you hear about us?

Let us know how you heard of Volunteer Polk. Select the most accurate option. If "other" please explain.

Recruitment:

'Other' - Please explain:

'Employee of PC' - Who?:

Message

Please write anything you would like to share.

RSVP Enrolled Volunteers ONLY

If you are age 55 or older, are you currently enrolled in RSVP Polk? (Michelle Shiver)

RSVP Enrolled:

Florida Retirement System

Please note the volunteer opportunities on this application are with locations that participate in the Florida Retirement System (FRS). If you are enrolled with FRS from any FRS participating location, have retired, and are now wanting to volunteer, please contact FRS. Depending on your retirement plan and recent activity on the plan you will need to determine how long your individual waiting period is before you may be a volunteer with a FRS participating location without interrupting your distributions.

We cannot contact FRS on your behalf as they need personal information from you to access your plan. Thank you.

FRS Acknowledgement:

Screening Authorization

All the volunteer opportunities associated with this application require screening of some level. This could be screening for a volunteering history with a division or program of the Board of County Commissioners, a background screen, and/or a National Sex Offender Registry screen. Some assignments due to their involvement with vulnerable populations will require higher screening levels.

Screenings are valid for 5 years and will be renewed on those who:

- are still active 5 years after their initial screening

- returning volunteers who wish to have their file reactivated after 5 years from the initial screening

- warrant a rescreen after an incident while volunteering

By selecting "I agree" you allow Volunteer Polk to use your personal information provided on this application to conduct the necessary screens for your placement. You also agree you have reviewed the assignment qualifications and feel you meet the minimum requirements for placement.

I Agree

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