Volunteer Opportunities Form

Last Name: First Name:
Middle:
Address:
City: State: Zip:
Primary phone: Secondary phone:
Email: Date of Birth:
School: Grade / Level:
Whom should we contact in case of an emergency?
Name: Relationship:
Phone:
Phone 2:
Type of Volunteer opportunity your interested in (please choose two)
 Animal Veterinary Horticulture Special Events Education Guest Services FOTZ (Friends of the Topeka Zoo)
Parent / Guardian (if under 18):

Availability
Please indicate what days of the week and times you’re interested in working. A more formal schedule will be created after your interview.
 Monday Tuesday Wednesday Thursday Friday Saturday Sunday
Do you have any other commitments that may interfere with your availability?
Do you have any allergies or disabilities? Please list them so we can accommodate accordingly.

Background
Are you presently employed?
Job Title: Supervisor’s Name and Number:
Duties performed:
May we contact your employer?  YES NO
Average #’s of
Hours worked per week:
Please list 3 references
1)
2)
3)
In the past 7 years have you been convicted of a crime (misdemeanor or felony)?  YES NO
(A conviction includes a plea, or a finding of guilt regardless of whether or not sentence was imposed by the court.)
If yes, please explain and include charge, date of conviction, and place of conviction.

General Information
Why do you want to volunteer at the Topeka Zoo?
What do you see yourself doing while volunteering here?
What purpose do you believe zoos and aquariums serve?
I certify to the best of my knowledge, all information I am providing the Topeka Zoo is accurate and complete. I understand that any misrepresentations, falsification, or willful omission may result in a refusal of volunteer service or dismissal from volunteer service.

I understand that routine inquiry may be made during the processing of this information that will provide or confirm information concerning my character, general reputation, and qualification.

Digital Signature:
Date:
Parent / Guardian Signature:

 

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