First Name*

Last Name*

Address*

Phone Number*

Secondary Phone Number

Email Address*

Employment Status*

Full Time Part Time

Retired Other

Are you currently a student?*

Yes, Full Time Yes, Part Time

No

If yes, list current school and grade

If you require a specific number of volunteer hours, please specify hours and deadline below

Which Town of Los Gatos Volunteer position(s) are you interested in? *

Current volunteer opportunities are listed on our Community Unity webpage at www.LosGatosCA.gov/CU,
or by following the link below:

COMMUNITY UNITY

Availability *

Sunday Monday Tuesday Wednesday

Thursday Friday Saturday

Preferred Times*

Desired numbers of hours per week*

List any previous volunteer experience*

Please provide one reference (Non-relative)

Name*

Relationship*

Phone Number *

Email Address*

Emergency Contact Information

Name

Relationship*

Phone Number:*

Secondary Phone Number

Have you ever been convicted of a felony?*

Yes

No

If yes, please specify:

I declare under penalty of perjury that the statements made in this application are true, and I acknowledge that any false statements or
misrepresentations on this application may be cause for refusal of placement or immediate dismissal from volunteer status. I further authorize the Town of Los Gatos to investigate the matters contained in this application, and I am aware that fingerprinting and background investigation are required for placement in any sensitive volunteer positions.*

I agree

I do not agree

If under the age of 18, parent or guardian consent is required to participate in this volunteer program. Please check the box below if you are 18 or older.

I certify that I am 18 years of age or older

If applicant is under the age of 18, a parent or guardian must give consent by intialing below: