Westfield Athenaeum Library
Volunteer Application Form
We love volunteers! If you would like to volunteer your time at the Westfield Athenaeum, please fill in the application form below, print it out and either drop it off at the library or send it to:
Westfield Athenaeum
6 Elm St.
Westfield, MA 01085
Attn: Candy Pennington
After we receive your application, we will contact you for an interview, so we can discuss our volunteer opportunities with you in person. Volunteers will be asked to complete a CORI form.
Your Name and Address:
First and Last Name(s): ____________________________________________
Home Address:_______________________________________City _________, State ___.
Home Telephone: (413) ______ _________
Education:
High School - If student, list current grade: ____________________ ______
College Attended: ____________________________, State ________
List any Certificates or Degrees: _____________, ____________, ___________
Special Skills:
(such as typing, familiarity with computer software, etc.)
Previous Work Experience (Give brief description)
Previous Volunteer Experience (Give brief description)
List one Personal Reference :
First and Last Name(s): ____________________________________________
Address:________________________________________City _________, State ___.
Home Telephone: (413) ______ _________
Person to be notified in case of emergency:
First and Last Name(s):______________________ ___________________
Address:________________________________________City _________, State ___.
Home Telephone: (413) ______ _________
Job Interests/Responsibilities:
Please check all that are of interest to you.
Clerical Computer Mending books Artwork
Work with the Historical Museum Shelf reading/Shelving books
Working with children (requires background check)
Working with young adults Summer Reading Club help
Yard work I want to know my options
Available Hours:
Daytime - morning Daytime - afternoon
Weekends Special events
Availability - Long or Short Term:
A week or two Three months Six months
Nine months (school year) Ongoing
Volunteer Signature:_______________________________
Date: _______________
Parent or Guardian Signature: _________________________(if volunteer is under 16 years of age)
Westfield Athenaeum 6 Elm Street Westfield, MA 01085-2997
CORI REQUEST FORM
WESTP
FE2103
Westfield Athenaeum has been certified by the Massachusetts Criminal System History Board, pursuant to M. G. L. c6, section 172H, for access to conviction and pending criminal case data. I, ___________________________, as a volunteer, understand that a criminal record check will be ocnducted for conviction and pending criminal case information only and that it will not necessarily disqualify me. The information below is correct to the best of my knowldege.
Applicant Signature: __________________________________
Applicant Information (please print)
Last: ___________________ First: __________________Middle Name:_______
Maiden Name or Alias (if applicable)_________________Place of Birth:________
Date of Birth: ______________ Mother's Maiden Name: ___________________
Social Security Number (optional) ____,_____,___ Id Theft Pin (if applicable)____
Current and Former Addresses: - List at Least 2
_______________________________________________City _________, ___
_______________________________________________City _________, ___
Gender: _____ Height: Ft.____ In. ____ Weight: _____ Eye Color: ______
State Driver's License Number: _____________________ State issued:_______
The above information was verified by reviewing the following form of Government issued phtographic identification: __________________________.
Requested by:____________________________ (Signature of CORI Authorized Employee)
