HomeMy WebLinkAboutApplication - Larson, William - 11/24/2014VU
NOV.25 2014
69.
City of Nenton Volunteer Application
MAYOR’S OFFICE
Personal Intormation
Name:J3/L/A’fl4.,q i3c1j’j
___
Date:’L)(’,
Address:)4t Nit-i City/State/Zip:kJit’iJ CL1 9&i%7
Home Phone/-21,5?2fr Work Phone:‘——-—Cell Phone2.,/%7
In case of emergency,please notify:
Name:14A (_UJ-k..37L-Relationship:’_______________
Home Phone:1-E,3 ‘i 4qE?#-Cell Phone.2t’i’?7’2 Aa Business Phone:7 7t)
Past cxvcrience
Employment and/or Volunteer Experience:3/V1 A7W2AJuQi,iu,ôtJ ici.1ff
Education/Training:i,’CJ’,.fz,/1_iJjC’L 1 1
Special skills or hobbies:tQJOO)(iJ&iiJ,,“,ti-/i4 /7Lf1 t[t)t\f(.1 t
Volunteer Opportunities
____________
There are a variety of volunteer opportunities in the City of Renton.In order to provide maximum
satisfaction,individual volunteers will be carefully matched according to their choice,skills,and available
assignments.
Do you have a volunteer preference:tI..L],’L SEjcjf_i -&‘ib 2.iiiLf
Department or Division:____________________________
_____________________________
Tim Available:Morninq)(’Afternoon Evening,’
Tues Wed Thurs Fri Weekends
Beterences
List two references (other than family)whom the City can contact,and their relationship to you (friend,
employer,etc.)
Name:2AT akT Phone5 Z 1?C9/O
Address:/O tAi \LL)f’?-P City/State/Zip:7VIU LC)/A47
Name:J FIe:()t 7t7 Relationship:
Address:6O5O /-A’t1.S
______
City/State/Zip:AJc4uAJ Li)/y2
Background Statement
By my signature,I authorize he,City of Renton,tf p orna background check of my criminal record.
Applicant Signature:
Mail to:City of Renton,Volunteer Program -Community Services Department
1055 S.Grady Way,Renton,WA 98057 (425)430-6600
Background Questionnaire and Disclosure Notice?Yes No Dept.for Placement:__________________
HR Approval for Placement?Yes No Date Approved By HR_________________