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.