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Thank you for your interest in volunteering!

The City of Ellensburg Parks & Recreation Department is currently accepting applications for various volunteer positions.

To ensure proper consideration, please fill in the information below as completely and accurately as possible, including which divisions/positions you are interested in. You will also be required to complete and upload a Washington State Patrol Background Check form as well as a photocopy of your valid state driver’s license or state identification before you can submit your application.

NOTE: If you require any special accommodation in filling out this application, please call (509) 962-7222.

Parks & Recreation - Volunteer Application

First Name *

Last Name *

Middle Name (type NA if none) *

Current Address *

City/State/Zip *

Mailing Address (if different)

City/State/Zip

Email Address *

Phone Number *

Which Parks & Rec division(s) would you like to volunteer with? *

Stan Basset Youth Center

Sports

Adult Activity Center

Kittitas Valley Memorial Pool

What positions are you interested in? *

Sports Coach

General Volunteer

Other Other

What days of the week are you available? *

Please indicate the times you are available each day - for example, 3 - 5 PM, etc. *

Current/Most Recent Employer or Volunteer Organization Name

Supervisor's Name

Start Date

End Date

Reason for Leaving (if applicable)

Did you supervise others, and if yes, how many?

What were your duties and responsibilities?

0/5000 characters

Previous Employer or Volunteer Organization Name

Supervisor's Name

Start Date

End Date

Reason for Leaving (if applicable)

Did you supervise others and if yes, how many?

What were your duties and responsibilities?

0/5000 characters

Previous Employer or Volunteer Organization Name

Supervisor's Name

Start Date

End Date

Reason for Leaving (if applicable)

Did you supervise others and if yes, how many?

What were your duties and responsibilities?

0/5000 characters

Please tell us about any other volunteer experience not listed above. Include the organization name, dates of service, types of duties performed, and a contact name, number, and/or email address for the organization.

0/5000 characters

Please list any related professional skills and qualifications you have that would contribute to and/or benefit our programs and the participants.

0/5000 characters

Please include any additional information you feel may be helpful to us - but please do not include personal information, such as health or disability status. Reasonable accommodation may be considered if medically necessary for volunteers to perform the duties successfully.

0/5000 characters

Are you currently First Aid/CPR Certified? *

Yes

No

Please select if you are also AED certified

Do you have a current/valid driver's license? *

Yes

No

Do you have experience driving a 15-passenger van? *

Yes

No

Other (explain) Other (explain)

Professional Reference #1 *

Email Address (Preferred)

Phone Number *

How do you know this person? *

Professional Reference #2 *

Email Address (Preferred)

Phone Number *

How do you know this person? *

Professional Reference #3 *

Email Address (Preferred)

Phone Number *

How do you know this person? *

Volunteer Acknowledgment - Volunteers are not considered to be City of Ellensburg employees. Injury compensation is provided through the Department of Labor & Industries. Volunteer service is considered to be creditable work experience. The data furnished on this form is provided by you voluntarily and will be used to contact, interview, and place volunteers. *

I have read the acknowledgment and I understand and accept it.

SIGNATURE IS REQUIRED: To the best of my knowledge, the information herein is true and complete. I understand that falsification of this application is grounds for dismissal as a volunteer. Further I give permission for an authorized representative of the City of Ellensburg to conduct a state patrol criminal background check in accordance with RCW 43.43.830-839 and to inquire of individuals about my ability to perform all aspects of the volunteer position for which I am being considered and I release the City of Ellensburg and those individuals/institutions that provide information from any liability that may arise from the provision of this information. As a volunteer for the City of Ellensburg, I am fully aware that the work associated with being a City Volunteer involves certain risks of physical injury or death. Being fully informed as to these risks and in consideration of my being allowed to participate in the City’s Volunteer Program, I hereby assume all risk of injury, damage and harm to myself arising from such activities or use of City facilities. I also hereby individually and on behalf of my heirs, executors and assignees, release and hold harmless the City of Ellensburg, its officials, employees and agents and waive any right of recovery that I might have to bring a claim or a lawsuit against them for any personal injury, death or other consequences occurring to me arising out of my volunteer activities. I give permission to have my photo taken and used for publicity purposes by the City. I authorize any necessary emergency medical treatment that might be required for me in the event of physical injury and/or accident to me while participating in this program. *

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Date Signed * +

Background Check

The City of Ellensburg may initiate request for conviction criminal history record (RCW 10.97) through the Washington State Patrol. Please provide the following information to prevent delay of the volunteer selection process.

Applicant's Name (Last, First, Middle) *

Alias/Maiden Name/Other Names Used (if none, type N/A) *

Date of Birth * +

Please upload a copy of your photo ID. *

Disclosure Statement

Pursuant to RCW 43.43.834, we must ask you to complete the following disclosure statement. This information will be kept confidential.

1. Have you ever been convicted of a crime against persons? (A crime against persons includes any of the following offenses: Aggravated murder; first or second degree murder; first or second degree kidnapping; first, second or third degree assault; first, second or third degree rape; first, second or third degree statutory rape; first or second degree robbery; first degree arson; first degree burglary; first or second degree manslaughter; first or second degree extortion; indecent liberties; incest; vehicular homicide; first degree promoting prostitution; communication with a minor; unlawful imprisonment; simple assault; sexual exploitation of minors; first or second degree criminal mistreatment; or any of these crimes as they may be renamed in the future). *

Yes

No

If your answer is "YES", please describe and provide the date(s) of the conviction(s) and the sentence(s) imposed.

2. Have you had any findings made against you in any civil adjudicative proceeding? *

Yes

No

If your answer is "YES", please describe and provide the date(s) of the finding(s) and the penalty(ies) imposed.

3. Have you had both a conviction and findings made against you? *

Yes

No

We may request your fingerprints to obtain from the Washington State Patrol Criminal Identification System a report of your record of criminal convictions for offenses against persons, civil adjudications of child abuse, and disciplinary board final decisions. If you are hired before that report is available, YOUR EMPLOYMENT WILL BE CONDITIONED UPON THE RECEIPT OF A SATISFACTORY REPORT.

You will be notified by email of the State Patrol's response within ten (10) days after we receive the report. We will make a copy of the report available to you upon your request.

UNDER PENALTY OF PERJURY, I certify that the above information is true, correct and complete. I understand that if I am hired, I can 'be discharged for any misrepresentation or omission in the above statement. I also understand that if I am hired, my employment is conditioned on your receipt of a satisfactory report from the Washington State Patrol.

*

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Typed Name *

Date Signed * +