2. Date
   Date
4. First Name
5. Last Name
7. Address
9. City
10. State
11. Zip
13. Daytime phone number
14. Email address
16. Driver license number
17. Date of birth
    Date of birth
19. Can you operate any special equipment?
21. Are you a board or committee member for the Village?

    1. Yes
    2. No
23. Which board or committee?
25. Please summarize any special skills or qualifications
27. Why are you interested in volunteering for the Village?
29. Please list any previous volunteer experience you've had
31. Code of Ethics
    The Village of North Palm Beach employees and volunteers are required to abide by the State of Florida and Palm Beach County Code of Ethics and must avoid conflicts of interest. These laws limit or prohibit certain types of relationships between Village employees, vendors, lobbyists and others.
33. Do you have any relatives currently employed or holding elected board positions at the Village of North Palm Beach?

    1. Yes
    2. No
35. Please identify the person and position held
37. Do you or any family members provide goods or services to the Village government?

    1. Yes
    2. No
39. Please identify the person and position held
41. Emergency contact name
43. Emergency contact phone number
45. Reference 1
46. Occupation
47. Phone number
49. Reference 2
50. Occupation
51. Phone number
53. Reference 3
54. Occupation
55. Phone number
57. By submitting this form you are agreeing to the following:
    I hereby certify that the answers given to the foregoing questions and statements are true and correct. authorize the Village of North Palm Beach to investigate and verify any or all of the information contained in this application. I understand that volunteer service is subject to successful completion of a background check, and any misrepresentation of facts will be cause for dismissal or may disqualify me from consideration. Further, I understand and agree that any volunteer service project is for no definite period and may be terminated without previous notice. I acknowledge and agree that if at any time I am subjected to any type of discrimination or harassment, I will contact the Director of Human Resources or other management representative immediately to obtain assistance in the resolution of such matters. I understand that the Village has an anti-harassment policy and that the com plaint procedure stated within that pol icy should be utilized. Further, in accordance with Florida Public Records Law, Chapter 1 1 9, F S, information provided on this application may be "inspected and examined by any person desiring to do so, at any reasonable time, under reasonable conditions, and under supervision by the custodian of the public record or his designee."
59. Background check
    If selected a background check will be required. The Village of North Palm Beach is a Drug-Free Workplace and an Equal Opportunity Employer.
61. Contact us
    If you need more information, please call (561) 841-3376 or email jlobosky@village-npb.org.
Leave This Blank:


63. 1. Receive an email copy of this form.
64. Email address

    This field is not part of the form submission.

65. Submit

* indicates a required field