View Application Form (PDF).

City of Pinellas Park - Barbara S. Ponce Public Library Volunteer Application

Last Name ___________________________________________________________________________

First Name ___________________________________________________________________________

Initial _________

Birth Date_____________________________________________________________________________ 

Home Phone___________________________________________________________________________

Address _______________________________________________________________________________

Age (if <18) ____________ Soc Sec # _______________________________________________________

City _________________________________________State ________________Zip _________________

Gender M F       DL # ____________________________________________________________________

Email _________________________________________________________________________________ 

Dates available to volunteer: (Example: May 15 – Sep 30) 

Activity Interest : 

____ Library Gift Shop ____ Light Groundskeeping 

____ Processing New Library Materials ____ Shelving Books 

____ Book-drop/Check-in Assistant (inspect & scan-in materials) 

____ Light Dusting/Cleaning/Organizing 

____ Computer Helper (Provide assistance to users who need basic 

help at the computers, printers, copiers, etc.) 

____ ESL Conversation Partner (help an English-as-Second-Language 

student practice his/her English through everyday conversation) 

____ Craft Assistant (cut, paste, prepare/demo craft materials) 

____ Library Delivery Program (Select and/or deliver materials to those 

who cannot get to the library on their own.) 

Days/Hours available to volunteer: 








Special Skills, Hobbies, Training or Certifications That Might Come in Handy: 

Physical Limitations (ex: unable to stand for long periods of time, lifting heavy books, pushing carts, etc.): 

Employer, Volunteer, and Personal References 

Current or Most Recent Employer / Agency Supervisor Phone 

Work/Volunteer Activity (please indicate whether employee or volunteer) Dates 

Previous Employer / Agency Supervisor Phone 

Work/Volunteer Activity (please indicate whether employee or volunteer) Dates 

Employer / Agency Supervisor Phone 

Work/Volunteer Activity (please indicate whether employee or volunteer) Dates 

Personal Reference Relationship Phone 

Personal Reference Relationship Phone 

Personal Reference Relationship Phone 

Service Organizations (Girl / Boy Scouts, etc): 

Emergency Contacts: Daytime Phone: 

Volunteer Policies: 

• Volunteers will be under general supervision of the facility Manager and direct supervision by a Staff employee. Only the facility Manager may assign a volunteer. 

• Volunteers will be governed by the same rules and regulations as City employees. 

• Volunteers will be given a schedule and maintain a time card of volunteer hours worked. 

• Volunteers will be issued a Volunteer ID and must visibly wear it at all times when in City facilities. 

• Volunteers will be covered for volunteer work related injuries by the City’s Worker’s Compensation program. 

• Volunteers may be suspended or terminated for failure to comply with criteria stipulated by the volunteer agreement and job description applicable to the volunteer location and / or activity, or for violation of the Code of Conduct. 

Criminal History: Have you ever been convicted, pled nolo contendere, been placed on probation, fined, entered a pretrial intervention program, or had adjudication withheld for a crime other than for minor traffic violations: YES _____ NO _____ 

If ‘Yes’, please give dates and details (i.e. when the offense occurred, the type of offense(s), the location and the outcome or disposition [Attach additional documentation as required]: 

Authorization and Release 

The undersigned, in consideration of the acceptance of this Application and by participation in the programs and activities of the Library Division of the City of Pinellas Park, Florida (hereinafter the “City”), hereby irrevocably releases the City from any and all claims for injury or property damage arising out of or resulting from the applicant’s participation in any of the City’s Library Division programs or activities. As used herein, the term “City” includes the City, its agents, employees, officials, and volunteers, individually and collectively. 

Failure of the applicant to comply with or to conform to the City’s established rules and regulations shall result in the applicant’s suspension or dismissal from the City’s Library Division programs and/or activities without refund of any monies paid. 

By signing this form below, the undersigned certifies that all information provided by undersigned herein is true and correct, and further acknowledges that he/ she has fully read this form in its entirety and understands the same. All provisions hereof shall be binding upon the undersigned, his / her heirs, assigns, and legal representatives. 

Applicant Signature Date: 

Parent/ Guardian Signature (if applicant under 18) Date: 

Parent/Guardian Printed Name: