CitySERVE Application

Thank you for you interest in serving as a volunteer with CitySERVE and the City of Santa Cruz. Once you have selected a volunteer opportunity/internship, please complete the following application to begin the placement process.

You may download a PDF version of this application HERE

If you would like assistance finding a volunteer placement - please visit the Volunteer Referral Website HERE. You may also find open volunteer positions at www.scvolunteernow.org

The application includes the following sections:

Volunteer Application
Volunteer Agreement & Release of Liability
Volunteer Contract Agreement

Suplemental Information:

Fingerprinting Procedure: required for volunteers that handle money or confidential documents or who interact directly with children. View and Download the Fingerprinting Instructions here
CitySERVE Insurance Overview: a summary of the insurance coverage offered to all City of Santa Cruz volunteers while performing volunteer duties. View and Download the Insurance Overview Here

For additional questions please contact Johnny Shamoun at the CitySERVE office: [email protected], (831)420-5403

Volunteer Application CitySERVE

Please complete this application to for an internship or volunteer position with any department at the City of Santa Cruz

Step 1 of 4

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About You

Your Name(Required)

First Last

Your Email Address(Required)

Enter Email Confirm Email

Address(Required)

Street Address City State / Province / Region ZIP / Postal Code

Phone(Required)

Are you 18 years of age or older?(Required)

Yes

If you are UNDER 18 - What is your birthday?

MM slash DD slash YYYY

Are you currently a student? If yes, what school are you attending?

Leave blank if you are not a student

Are you or have you ever been an employee of the City of Santa Cruz?(Required)

Yes, I'm currently an employee (please list department below)

Yes, I worked at the City in the past (please list termination date below)

If Yes, What Department do you work at now? OR when did you stop working at the City?

Please tell us what department you work in - IF you are a current employee of the City OR when you stopped working if you are a past employee.

Preferred Days to Volunteer

Monday

Tuesday

Wednesday

Thursday

Friday

Saturday

Sunday

Preferred Time of day to Volunteer

Mornings

Afternoons

Evenings

No Preference / Flexible

Length of commitment you seek

How long do you want to volunteer

Less than 3-months

3-6 months

6-12 months

Ongoing/ As long as needed

Are you volunteering to complete COURT ORDERED COMMUNITY SERVICE?(Required)

YES

Other

How many hours per week do you want to volunteer?

You may also indicate once a month or less frequent interest. If you are only available on certain days or times please indicate.

What are your goals for a volunteer position?(Required)

Emergency Contact(Required)

Name

Relationship

Emergency Contact Phone(Required)

Upload Your Resume and Cover Letter- Required for INTERNS

If you are applying for an internship, please upload your resume in .pdf, .doc or .docx format. You may also send your resume at a later date.

Drop files here or

Accepted file types: pdf, doc, docx, Max. file size: 25 MB.

Signature(Required)

I hereby certify that all statements made in this application are true, and I authorize investigations of all matters contained in this interest form. I am aware that fingerprinting is required for all volunteer assignments that have access to children, confidential material or money. I understand that this is a non-paid position with no promise, expressed or implied, of consideration for future employment.

Todays Date(Required)

MM slash DD slash YYYY

Signature of Parent or Guardian

If applicant is under 18.

Todays Date

MM slash DD slash YYYY

About your volunteer position

Our goal is to place volunteers with programs within the City of Santa Cruz as efficiently as possible. Please answer all questions to the best of your ability and write "I don't Know" if you don't know the answer to a question.

Have you been in contact with a City staff member?(Required)

If so, please put their name in the "Volunteer Supervisor" field below.

Yes, I know where I want to volunteer and when I want to start

Yes, but I am not sure exactly where I will volunteer

No, I want help finding a volunteer placement

Other

Volunteer Supervisor(Required)

If you know who you will be volunteering with, please give their name. You may also put "I don't know"

Department or Program(Required)

Where are you planning to volunteer? If you don't know write "I Don't Know"

Desired Start Date

When do you want to start volunteering

MM slash DD slash YYYY

MORE ABOUT YOU

The following information is voluntary and it will help our program evaluate its recruitment practices and compile required statistical reports. The information will not be used to discriminate against, or give preference to, any individual in any volunteer position. Thank you for your cooperation.

Ethnicity / Race(Required)

White/Caucasian

Hispanic/Latino

Asian/Pacific Islander

African American/Black

Native American/Alaskan Native

Decline to State

Other

Gender Identity(Required)

Woman

Man

Non-Binary

Transgender Man

Transgender Woman

Prefer not to State

Other

VOLUNTEER AGREEMENT AND RELEASE OF LIABILITY

CitySERVE is a volunteer program created by the Volunteer Center of Santa Cruz County ("Volunteer Center") and the City of Santa Cruz ("City") in order to provide volunteer opportunities to the community while improving the City. Participation with CitySERVE is strictly voluntary and bound by the terms of this Agreement. No person may volunteer with CitySERVE prior to CitySERVE's receipt of this completed Agreement.

Terms and Conditions(Required)

1. By signing this Agreement I acknowledge that I am not an employee of the City Department in which I am applying to volunteer or the Volunteer Center and that my performance of voluntary services will be uncompensated. I agree that I will NOT use power equipment, or stand on any object taller than two (2) feet tall or otherwise engage in dangerous activities while volunteering with CitySERVE. I will not drive any City automobile connection with my volunteer services.

2. I hereby agree to release and hold harmless the City of Santa Cruz, its officers, agents, employees, and volunteers, including Santa Cruz Public Libraries, for any claim for personal injuries and damage to property that I, or anyone claiming under me or on my behalf, may incur arising out of or in any manner related to the performance of my voluntary services or participation with CitySERVE.

3. While participating as a volunteer with CitySERVE, I hereby authorize the taking of my picture, by photograph, movie, or videotape or otherwise ("pictures") for use by the CitySERVE program. I hereby irrevocably consent to and authorize the use and reproduction of such pictures for use by CitySERVE without compensation.

4. As a CitySERVE volunteer, you are covered by the Volunteer Center's Volunteer Accident and Personal Injury Insurance should you be injured while volunteering in assigned duties that are consistent with the safety rules outlined in this agreement. Please report any injuries immediately to your supervisor, or call the CitySERVE office at (831)420-5403

I agree to the terms and conditions.

Name(Required)

First Last

Signature(Required)

Date(Required)

MM slash DD slash YYYY

IF VOLUNTEER IS UNDER 18, PARENT OR GUARDIAN MUST SIGN BELOW

On behalf of my child, myself, and our representatives, I do hereby consent to allow my child, (named above), to participate as a volunteer with CitySERVE, subject to all of the terms and conditions above. I further expressly agree, on behalf of my child, myself, and our representatives, to all of the terms and conditions above, including but not limited to paragraphs 1, 2, 3 and 4.

Name of Parent/Guardian

First Last

Date

MM slash DD slash YYYY

VOLUNTEER CONTRACT AGREEMENT

IF YOU HAVE ALREADY CONNECTED WITH A CITY OF SANTA CRUZ SUPERVISOR/STAFF MEMBER - PLEASE COMPLETE THIS SECTION. If you are not sure where / who you will be volunteering with, you can leave this blank and complete with your supervisor.
Contract must be completed before volunteer begins assignment City of Santa Cruz

Your Name

First Last

Volunteer Supervisor

Phone (volunteer supervisor)

Department/ Division / Project

Address / Rm of volunteer project

START DATE

MM slash DD slash YYYY

END DATE

NOT TO EXCEED ONE YEAR

MM slash DD slash YYYY

Estimated hours per month

Volunteer Supervisor Responsabilities

• Complete any legal requirements (background check, fingerprinting, etc.) before volunteer starts
• Provide initial and ongoing training and supervision
• Complete contract with volunteer and return to VIP Program Coordinator
• Inform the VIP Program Coordinator at (831) 454-2987 and Risk Management at (831) 454-2253 of any injuries occurring while the volunteer is on assignment
• Contact VIP Program Coordinator regarding any problems during the contract period
• Inform VIP Program Coordinator if volunteer vacates position
• Log in volunteer hours and report to VIP Program Coordinator at the end of each month

Volunteer Responsibilities

• Log in volunteer hours on timesheets provided
• Return volunteer timesheets to VIP Program Coordinator at the end of each month
• Arrive to assignment on time; inform supervisor if you will be late or absent
• Fulfill time commitment, as listed below
• Contact VIP Program Coordinator at (831)454-2987 and Risk Management at (831) 454-2253 of any injury occurring while on volunteer assignment
• Contact VIP Program Coordinator when (or before) leaving position

Volunteer Signature

I understand that as a CitySERVE volunteer I am covered while volunteering under CitySERE's Volunteer Insurance, and am not covered under the City of Santa Cruz's Worker's Compensation policy. I further understand that the insurance provided by CitySERVE is excess insurance secondary to my existing insurance, should I have insurance. Furthermore, I understand and agree to the responsibilities expected of me while volunteering.

Volunteer Supervisor Signature - this will be sent to your supervisor to sign

I understand and agree to the responsibilities expected of me as a volunteer supervisor and understand that volunteers are covered under volunteer insurance purchased by the Volunteer Center of Santa Cruz County.

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Volunteer Application CitySERVE

About You

MORE ABOUT YOU

VOLUNTEER AGREEMENT AND RELEASE OF LIABILITY

VOLUNTEER CONTRACT AGREEMENT

Volunteer Supervisor Responsabilities

Volunteer Responsibilities

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