PCF Volunteer Application

    A response will be emailed to your email provided below.

    Your Information

    Name (first middle last):

    Email:

    Cell Phone Number:

    Home Phone Number:

    Work Phone Number:

    State or Country of Birth:

    Date of Birth:

    Social Security Number:

    Driver License Number (include state):

    Address (include street, city, state, & zip):

    Current Employer (include city):

    Employment Hire Date:

    Have you ever been convicted of an offense other than a minor traffic violation:

    noyes

    If Yes, Explain Here:

    Do you use illegal drugs or abuse prescription drugs:

    noyes

    If Yes, Explain Here:

    Describe the volunteer services you would like to perform or be involved with (include days and times of availability):

    Emergency Contact Information

    Name (first middle last):

    Address (include street, city, state, & zip):

    Cell Phone Number:

    Home Phone Number:

    Work Phone Number:

    Agreement

    PLEASE READ THE FOLLOWING STATEMENT CAREFULLY BEFORE SUBMITTING. By submitting this application, I affirm that the facts set forth in it are true and complete. I understand that if I am accepted as a volunteer, any false statements, omissions, or other misrepresentations made by me on this application may result in my immediate dismissal and that criminal charges may be brought against me. I understand that, if approved, I will not be an employee of Washington County, but rather, an unpaid volunteer. I understand that, if approved, I may be asked to voluntarily submit to a drug test and that a refusal will automatically disqualify me. I understand that, if approved, and if I were injured as a volunteer, I would be entitled only to medical benefits under Worker’s Compensation. I hereby authorize the Washington County Sheriff’s Office to conduct an investigative search of my past records and background. I further authorize the WCSO’s representatives to investigate and determine my qualifications through contact with my employer and others who have knowledge concerning my abilities, aptitudes, and behaviors.