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(S4) Volunteer Application Form

  1. Campbell County Public Safety Document Header
  2. Volunteer Application Form
  3. Volunteer Information
  4. Race
  5. Gender
  6. Education
  7. High School Diploma Received?
  8. Experience
  9. Health Information
  10. References

    Please list at least three (3) references, not related to you, who know your qualifications.

  11. Criminal History
  12. Have You Ever Been Convicted Of A Criminal Offense, Including Moving Violations?
  13. Electronic Signature Agreement

    By checking the "I agree" box below, you agree and acknowledge that: 

    • 1) your submission will not be signed in the sense of a traditional paper document;
    • 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature; and 
    • 3) you may still be required to provide a traditional signature at a later date.

    Further, by checking the "I agree" box, you indicate that you give the department permission to conduct/request a background investigation, including a criminal and driving record check for possible criminal or traffic violations and license status.

    *If submission is for someone under the age of eighteen (18) a parent/legal guardian signature is required.

  14. Leave This Blank:

  15. This field is not part of the form submission.