NEW Zoo of Brown County, WI

1. First Name
2. Middle Name
3. Last Name

4. Date Of Birth

   Month January February March April May June July August September October November December Day 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Year 2010 2009 2008 2007 2006 2005 2004 2003 2002 2001 2000 1999 1998 1997 1996 1995 1994 1993 1992 1991 1990 1989 1988 1987 1986 1985 1984 1983 1982 1981 1980 1979 1978 1977 1976 1975 1974 1973 1972 1971 1970 1969 1968 1967 1966 1965 1964 1963 1962 1961 1960 1959 1958 1957 1956 1955 1954 1953 1952 1951 1950 1949 1948 1947 1946 1945 1944 1943 1942 1941 1940 1939 1938 1937 1936 1935 1934 1933 1932 1931 1930 1929 1928 1927 1926 1925 1924 1923 1922 1921 1920 1919 1918 1917 1916 1915 1914 1913 1912 1911 1910
5. Email
6. Home Phone
7. Work Phone
8. Address, City, State, Zip

1. Emergency Contact Name
2. Emergency Contact Phone

1. Volunteer Opportunities Interested In
2. Your Experiences, Education and Personal Qualities
3. Previous Volunteer Experiences

4. What days are you available to volunteer?

   Monday Tuesday Wednesday Thursday Friday Saturday Sunday
5. What times and or how many hours per week can you volunteer?
6. How long do you plan to volunteer?

Current Employer

1. Name
2. Contact Information (Name and Phone Number)
3. Dates Employed (mm-yyyy to mm-yyyy)

Previous Employer

1. Name
2. Contact Information (Name and Phone Number)
3. Dates Employed (mm-yyyy to mm-yyyy)

Reference One

1. Name
2. Relationship
3. Phone Number
4. Email

Reference Two

1. Name
2. Relationship
3. Phone Number
4. Email

Reference Three

1. Name
2. Relationship
3. Phone Number
4. Email

1. Read Carefully Before accept the Volunteer Application Terms.

   I hereby certify that all statements made on, or in connection with, my application are true, complete and correct to the best of my knowledge and belief. I understand and agree that any misstatements or omissions of material fact subject me to disqualification or, if accepted as a volunteer, dismissal.

   I authorize any person contacted to provide Brown County any and all information regarding my employment, education, and other information concerning any of the subjects covered by the application which may include but not limited to: Application of employment; performance evaluations; work records; supervisor’s comments; disciplinary reports or letters; and complaints or allegations regarding any misconduct. I agree to execute release authorization forms required by Brown County to request employment records from my present and/or former employer(s). I release and hold harmless Brown County, their officers, agents, and employees, and the person(s) providing the information, from any liability, related to the providing of this information.

   I authorize Brown County, its officers, agents, and employees to conduct a background check (including criminal) prior to making a decision regarding employment. I release and hold harmless Brown County, their officers, agents, and employees, and the person(s) providing the information, from any liability related to the performance or results of this check.

   If accepted as a volunteer, I agree that my status as a volunteer depends on my successful completion of a volunteer orientation session. I also agree that volunteering is a privilege and can be terminated at any time. In addition, I understand that Brown County maintains a drug-free and violence-free workplace.

   I accept the Volunteer Application Terms