Jacksonville.gov - Volunteer Application Form

Content

Volunteer Application Form

City of Jacksonville

Disabled Services Division

Volunteer Application

Application for membership as an Auxiliary Officer

Last Name, First Name

Street

City

State

ZIP Code

Home Phone

Work Phone

Cell Phone

Birth Date

Driver's License or State ID#

Employer

Education

Personal References

Reference 1 Name

Reference 1 Number

Reference 2 Name

Reference 2 Number

Work Experience

Name of Organization 1

Contact Number 1

Worked From

Worked To

Name of Organization 2

Contact Number 2

Worked From

Worked To

Have you ever pleaded "nolo contendere" to or been convicted or found guilty of a felony?

If yes, please explain

I verify that all information given in this application is true to the best of my ability. I authorize contact of listed references. I understand that misrepresentation or omission of facts requested is cause for non-appointment as a City of Jacksonville volunteer or for termination after appointment. Enter your name here

Today's Date

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The City of Jacksonville encourages persons with disabilities to participate in its programs and activities.
Requests for an accommodation should be submitted to the Disabled Services Division within a reasonable amount of time by contacting:

Kara Tucker
Chief, ADA Coordinator
Disabled Services Division
904-255-5472
karat@coj.net