Volunteer Application

Lucius Beebe Memorial Library

Name:________________________________________________________________________

Address:______________________________________________________________________

Telephone:____________________________________________________________________

Emergency Contact (Name, Phone):_______________________________________________

Name/Address of Most Recent Employer:_________________________________________

Dates of Employment:__________________________________________________________

Previous Volunteer Experience:__________________________________________________

______________________________________________________________________________

Employment Reference (Name, Phone, Address):___________________________________

______________________________________________________________________________

Personal Reference:_____________________________________________________________

Please list times and days on which you would prefer to volunteer:___________________

______________________________________________________________________________

The Commonwealth of Massachusetts now requires that all public organizations such as libraries conduct criminal background checks on any adult who has interactions with vulnerable groups, such as children, the elderly and the disabled. This extends to anyone interested in being a library volunteer.To conduct this check we will need your birth-date, your signature and a copy of one form of identification. The background information will be held in the strictest confidence – information will not be shared with anyone other than the individual who is the subject to the check. These checks were put in place in order to provide better security and safety for those most vulnerable groups in society. We appreciate your understanding and cooperation in complying.

Birth date:______________________Signature:____________________________________________________