Court Ordered Community Service Application Form

Please complete this application form if you are interested in completing your court ordered community service at Animal Care of Davis County. Once you complete the form, click the Continue button at the bottom.

NOTE: ANIMAL CARE OF DAVIS COUNTY IS HAPPY TO ASSIST YOU IN FULFILLING YOUR COURT ORDERED COMMUNITY SERVICE AS LONG AS YOUR CONVICTION DOES NOT INCLUDE A CHARGE FOR ANY OF THE FOLLOWING:

1. DOMESTIC VIOLENCE

2. ANIMAL CRUELTY

3. THEFT OR FRAUD

4. ANY TYPE OF SEXUALLY RELATED CRIME

5. ANY PROTECTIVE ORDER FOUND ON YOUR BACKGROUND CHECK

Name and address

First name:

Last name:

Middle name:

Title:

Additional Information

Nickname:

Type:

Date of birth:

Age:

Gender:

How did you hear about us?:

T-Shirt Size:

Contact Information

Education and Employment

You may optionally provide the following information. It is used only to help us get a better idea of the demographic make-up of our volunteers.

Some organizations also have a volunteer program that will donate funds equal to the amount of hours you volunteer. If you are aware that your company offers such a program please reach out to the volunteer coordinator at volunteer@co.davis.ut.us.

Education:

School:

Workplace:

Employer name:

Shift Availability

Please indicate the shifts you will regularly be able to commit to on a weekly basis. We are actively seeking to find volunteers that can commit to weekly service. If you are assigned to a specific shift and assignment and you are unable to fill that assignment we will work with you until it become a consistent issue.

Emergency Contacts

First name:

Last name:

Primary Phone phone:

* OK to call here

Work phone:

OK to call here

Secondary Phone phone:

OK to call here

Email address:

Relationship:

Limitations

Do you have limitations that we should consider with assigning volunteer jobs? Allergies, lifting limits, etc.

Please list any limitations you have.

Community Service

Have you ever been convicted of violating any law? No or yes? If yes, please provide details of conviction in the comment box below.

Number of hours needed::

Court Ordered:

School Required:

No or yes?

Volunteer Training

All volunteers must complete a Volunteer Orientation training before they can start volunteering. Our Orientation will cover who we are and the Davis County Policies. Orientation will be sent to you via email after submission of your application. Please choose one of the following dates to sign up for your tour of the facility.

Times

Assignment

Friday October 7, 2022:

3:30pm to 4:30pm

Volunteer Orientation

Tuesday October 11, 2022:

3:30pm to 4:30pm

Volunteer Orientation

Parent / Guardian Information

ALL MINORS BETWEEN THE AGES OF 12 AND 15 MUST BE ACCOMPANIED BY A PARENT AT ALL TIMES WHEN VOLUNTEERING. THE BELOW PORTION MUST BE FILLED OUT FOR ALL MINORS UNDER 18.

If you are a coach or caregiver for someone who wants to volunteer through one of our many partnerships or your organization wishes to begin a partnership with Animal Care of Davis County, please fill out the information below.

Employer name:

First name:

Last name:

City:

State:

Zip:

Primary Phone phone:

OK to call here

Work phone:

OK to call here

Secondary Phone phone:

OK to call here

Please list any limitations your relative or client may have.

Confirmation

I understand this acknowledgement does not create an obligation or contract of employment between Davis County and myself.

DAVIS COUNTY PRE-VOLUNTEER ALCOHOL AND DRUG TESTING NOTICE AND CONSENT: A drug test is not required before volunteering, but we may ask for one in the future if necessary.

As part of the volunteer process, I hereby voluntarily agree to be tested for the presence in my body of controlled substances. I will be given the opportunity to review Davis County's Drug Free Workplace Testing policy in Orientation. I understand that I must successfully pass a drug test as a condition precedent to my volunteering. Further, I understand that while I am volunteering by Davis County, I may be subject to drug testing under certain circumstances specified in the policy.

I hereby acknowledge and agree that my volunteering is conditional upon successfully passing the drug test. If needed be, I agree to report for a drug test at IHC Workmed within 24 hours of notification to report for drug testing. I understand and agree that if I do not successfully complete the drug test within 24 hours of receiving the authorization that I may lose the position that has been conditionally offered to me. I further agree to authorize the release of the results of these tests to Davis County. This release will expire six (6) months from the date submitted.

BACKGROUND CHECKS:

I hereby give Davis County permission to conduct any background checks necessary. I understand that all applicants wishing to volunteer alone must be at least 16 years of age or older and that all applicants between the ages of 10 and 15 or requiring a guardian must have a parent/ guardian present at all times while volunteering.

I hereby certify all statements made in this application and all other documents are true and complete. I understand and agree any misrepresentation herein shall be sufficient cause to deny volunteering or to terminate my volunteer service at any time.

I Agree