Volunteer Application

Personal Contact Information
Address
Employment (If Available)
If you're currently employed.
Work Address
Emergency Information
Spouse, Mother, Father, Son, Daughter, Brother, Sister, Uncle, Aunt, etc.
With Area Code
References
Provide two non-relative references who have known you for one year or more.
Reference 1
Street City, State Zip
Reference 2
Street City, State Zip
I give permission for photos or video of me to be used for publicity specific to the library’s purposes without remuneration or compensation.
Information

Please read completely and sign below.

Volunteers are persons doing State of Arizona tasks/activities under the direction and control of a State authorized official and are not paid.

I, the undersigned, understand that liability coverage is extended to volunteers acting at the direction of a State official and within the course and scope of State authorized activities. Volunteers of the State are provided the same liability protection afforded employees. Thus, volunteers acting within the course and scope of their State authorized activities may be covered for their liability exposure as authorized volunteers of the State.

I also understand that as a volunteer with the Arizona State Library, Archives, and Public Records, I am NOT covered by the State's workers' compensation plan if injured while participating in this program (except for volunteers covered pursuant to A.R.S. § 23-901). Volunteers are strongly encouraged to obtain their own medical coverage before participating in the program. When there is no other insurance in place Risk Management has purchased a volunteer accident medical and AD&D program. Claim forms can be obtained from the Risk Management web site at www.azrisk.state.az.us.

I hereby authorize the State Library, Archives, and Public Records to perform a Motor Vehicle Records inquiry if I drive a state vehicle, or drive my own vehicle on state business. I also agree to provide information concerning vehicle insurance coverage upon request. I understand that the State Library agency holds copyright and all other intellectual property rights to any works created as part of my position as a volunteer, and anything received or created while doing business for the agency may be considered a public record and belongs to the state. I have carefully read the above information and understand its contents. The above information provided by me is accurate.

Volunteer's Signature

Please digitally sign by entering your full name, birthday and today's date.