Volunteer Application

Volunteer Application
Rapid City Public Library
610 Quincy Street
Rapid City, South Dakota 57701
605-394-4171 EXT. 214

Equal Opportunity Employer Statement

Personal Information:
Last Name: First Name: Date:
Address Line 1:	Social Security Number:
Address LIne 2:	Telephone Number:
Email Address (optional):	Work Phone ( optional):
Emergency Contact:
Name:	Address Line 1:
Email (optional):	Address Line 2:
Phone:
Reference:
Personal Reference Name (please list one):
Relation:
Address Line 1:
Address Line 2:
Email (optional):
Phone:
As part of the Rapid City Public Library volunteer employment process, we will be checking your background relative to job and personal references, criminal record, credit and social services record. In order to do that, we must have your authorization. Have you ever been convicted in a court of law? Yes No
If yes, please list below any violation, other than minor traffic offenses, for which you were convicted. One or more convictions will not necessarily disqualify you from volunteering for the Rapid City Public Library.
Failure to disclose convictions may result in disqualification.
Offense:
Date:	Place:
Offense:
Date:	Place:
Offense:
Date:	Place:
If you are under 18, please discuss the volunteering opportunity with your Parent or guardian; we will need their Signature to complete the hiring process. Are you at least age 18? Yes No
Educational Background Choose the highest level of education that you have completed (must be at least entering 6th grade in year of application)

Would you be interested in pursuing a career in Library Science? Yes No
List schools that you have attended from the first to last.
1) Name:	Address:
Subject Studied:	Dates Attended:
Degree:
2) Name:	Address:
Subject Studied:	Dates Attended:
Degree:
3) Name:	Address:
Subject Studied:	Dates Attended:
Degree:
4) Name:	Address:
Subject Studied:	Dates Attended:
Degree:
Work History: Are you legally authorized to work in the United States? Yes No
State your work history including volunteer work and babysitting starting with your most recent or current job.
1) Company Name :
Supervisor:	Address:
Job Title:
Responsibilities:
Employment Dates: From	To
2) Company Name :
Supervisor:	Address:
Job Title:
Responsibilities:
Employment Dates: From	To
3) Company Name:
Supervisor:	Address:
Job Title:
Responsibilities:
Employment Dates: From	To
Interests: List any Special Skills that you may have and feel would be applicable to work as a library volunteer.
Please list any computer skills and software with which you may have familiarity.
Place a check mark next to positions for which you would be interested in applying.
Technica Services Assistant	Home Delivery Service Assistant
Circulation Assistant	Reference Assistant
Outreach Reader	Outreach Selector
Periodicals Assistant	Youth Services Assistant
Availability:
Regularly each week for hours per week
For a total of hours	Periodically on an on call basis
Summer only	Winter only
Other , Please secify
Do you have a valid drivers liscense? Yes No
IF yes, please fill in the number and the state it was issued from:
How did you hear about volunteer opportunities at the Rapid City Public Library?
You will be asked to sign the following during your interview
The undersigned hereby authorizes any state department of social services, any police department, and Rapid City Public Library, to obtain and/or release any and all information regarding the social services, work, credit, or criminal history of the undersigned applicant for consideration for volunteer employment by the Rapid City Public Library. The undersigned also understands that misrepresentation or omission of facts called for in the application is cause for cancellation of the application and/or separation from volunteer service.