Volunteer Application

Thank you for your interest in volunteering with the Chenango County Historical Society!

To be considered, please complete this form in its entirety; all information provided is confidential.

Once this application has been submitted, please allow up to three weeks for CCHS staff and volunteers to be in touch with you regarding a time to meet and discuss more information about our programs. All volunteers are asked to attend an introductory training session which is mandatory.

* are required sections

Name *

First

Last

Email *

Phone *

Address *

Address Line 1

Address Line 2

City

State

Zip Code

At this time, our organization is unable to accommodate volunteer staff under the age of 16. Are you at least 16 years old? *

Education

Highest degree/level completed *

Last School Attended *

Did you graduate from the last school you attended *

Employment

Current / Most recent job title

Current / Most recent place of employment

Current / Most recent supervisor

First

Last

Current / Most recent supervisor email

Current / Most recent supervisor phone

Volunteer Experience

Name of current / previous volunteer location(s)

Name of current / previous volunteer supervisor(s)

Previous location(s) contact information

Previous volunteer responsibilities / job(s)

Availability

What days and times are you available to volunteer on a weekly basis? (Please list below)

Are you willing/able to attend a mandatory volunteer training session? *

Skills, Interests, & Experiences

Why are you interested in volunteering with the Chenango County Historical Society (CCHS)? *

Please rank your level of interest in the following areas by dragging the slider left to right.

(1= Not Interested, 10 Very Interested)

Administrative Support

Selected Value: 5

Community Ambassador

Selected Value: 5

Construction Assistant

Selected Value: 5

Curatorial Assistant

Selected Value: 5

Field Trip Experience

Selected Value: 5

Maintenance Assistant

Selected Value: 5

Museum Ambassador

Selected Value: 5

Special Events

Selected Value: 5

Criminal History

Have you ever been convicted/pled guilty to a crime other than a traffic violation? *

Reference #1

Reference #1 Name

First

Last

Reference #1 Address

Address Line 1

Address Line 2

City

State

Zip Code

Reference #1 Relationship to you

Reference #1 Email

Reference #1 Phone

Reference #1 Occupation

Reference #2

Reference #2 Name

First

Last

Reference #2 Address

Address Line 1

Address Line 2

City

State

Zip Code

Reference #2 Relationship to you

Reference #2 Email

Reference #2 Phone

Reference #2 Occupation

Emergency Contact

Emergency Contact Name *

First

Last

Emergency Contact Address *

Address Line 1

Address Line 2

City

State

Zip Code

Emergency Contact Relationship to you *

Emergency Contact Phone *

Emergency Contact Email *

Emergency Contact Occupation

Volunteer Agreement

Volunteer Agreement *

I agree *

By submitting this form, I certify that the facts in this application are true, correct, and complete to the best of my knowledge, and I understand that falsified statements on this application shall be grounds for dismissal from service as a volunteer with CCHS. I authorize CCHS to check and verify all information on this application. (In order to perform due diligence in protecting the well-being and safety of those we serve, CCHS reserves the right to perform criminal background checks on any current employee, applicant or volunteer.) I fully release references, employers, and CCHS from any liability from the verification process. I understand that there will be an interview prior to my being accepted as a volunteer staff, and I will be expected to complete the required training, abiding by the CCHS Statement of Professional Standards and Ethics while serving as a volunteer.

Your Name *

First

Last

Today's Date *

Education

Employment

Volunteer Experience

Availability

Skills, Interests, & Experiences

Criminal History

Reference #1

Reference #2

Emergency Contact

Volunteer Agreement

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