Volunteer Program Application & Information

Please print all information clearly in ink.

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Completion of the volunteer program application does not guarantee placement or engagement as a City of Milpitas volunteer program participant. Qualified volunteer applicants are considered without regard to race, color, religion, sex, national origin, age, marital status, non-job related medical condition or disability. For more information please call (408) 586-3210.
Date Date / MM / DD YYYY
Choose one: *

Choose one: Miss Ms. Mrs. Mr.
I prefer to be called by the name:
Full Name: Full Name: * First Middle Last
Date of Birth: Date of Birth: * / MM / DD YYYY
Address: Address: *
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Daytime Phone: Daytime Phone: * - ### - ### ####
Evening Phone: Evening Phone: - ### - ### ####
Email Address: *
Driver's License No.:
Emergency Contact
Name: Name: * First Last
Relationship: *
Address: Address: *
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Daytime Phone: Daytime Phone: * - ### - ### ####
Evening Phone: Evening Phone: - ### - ### ####
Availability & Assignment Request
How often would you like to volunteer? *
Please list times and days you are available to volunteer:
Monday *
Tuesday *
Wednesday *
Thursday *
Friday *
Saturday
Sunday
Check all areas of interest: *

Check all areas of interest: Administrative Services Arts & Culture City Attorney City Commission Clerical Support Community Development Environment/Recycling Financial Services Foreign Language/Translating Marketing/Promotions Park Clean-up/Graffiti Planning/Engineering Police Department Public Works Reception/Greeter Recreation Senior Citizens/Programs Special Events Sports/Fitness Youth/Teen Programs Unpaid Internship Other: Other:
Volunteer/Internship assignment preference (optional):
Have you ever been convicted of a felony or misdemeanor (not including traffic citations)? *

Have you ever been convicted of a felony or misdemeanor (not including traffic citations)? Yes No
If "yes", please explain. A "yes" answer to this question is not an automatic bar to acceptance into the MVP program:
DO NOT SIGN THIS DOCUMENT BEFORE YOU READ IT AS IT CONTAINS A WAIVER AND RELEASE OF LIABILITY TO WHICH YOU WILL BE BOUND
I hereby give Milpitas Volunteer Services permission to request and obtain data pertinent to my volunteering at City of Milpitas programs for the individual named herein, and the California State Department of Justice if necessary. I also release from all liability or responsibility all persons and institutions supplying information. I certify that all statements made in this application are true and correct to the best of my knowledge, and I agree and understand that if I am accepted into the Milpitas Volunteer Partners program, any false statements may result in my dismissal.

I the undersigned do hereby agree to allow the individual named herein to participate in the Milpitas Volunteer Partners program and I further agree to indemnify and hold the City of Milpitas, its employees and contractors, harmless from and against any and all liability for any injury which may be suffered by the aforementioned individual arising out of or in any way connected with his/her participation in this program. I also agree to grant full permission to the City of Milpitas to use my name and any photographs, videographs, motion pictures or recordings for any publicity and promotion purposes without obligation or liability to me. I ACKNOWLEDGE THAT I HAVE CAREFULLY READ THIS WAIVER AND RELEASE AND I FULLY UNDERSTAND THAT, BY SIGNING BELOW, I AM WAIVING ANY RIGHT THAT I MAY HAVE TO BRING A LEGAL ACTION OR TO ASSERT A CLAIM AGAINST THE CITY OF MILPITAS FOR NEGLIGENCE.
Signature of Applicant: *
Date: Date: * / MM / DD YYYY
Signature of Parent/Legal Guardian (if under 18):
Date: Date: / MM / DD YYYY
Print Name of Parent/Legal Guardian:

Volunteer Program Application & Information

Volunteer Program Application & Information

Emergency Contact

Availability & Assignment Request