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Volunteer Application Form
Volunteer Application Form
City of Jacksonville
Disabled Services Division
Volunteer Application
Application for membership as an Auxiliary Parking Enforcement Officer
Last Name, First Name:
Street:
City:
State:
Zip Code:
Home Phone:
Work Phone:
Cell Phone:
Email:
Birth Date:
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Driver's License or State ID#:
Employer:
Education:
High School
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Personal References
Name:
Number:
Name:
Number:
Work Experience
Name of Organization:
Contact Number:
From:
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To:
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Name of Organization:
Contact Number:
From:
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To:
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Have you ever pleaded "nolo contendere" to or been convicted or found guilty of a felony?
Have you ever pleaded "nolo contendere" to or been convicted or found guilty of a felony?:
Yes
No
If yes, please explain:
If yes, please explain:
(Please give date, nature or offense and disposition)
It is mandatory that everyone must attach a medical statement from your doctor declaring that participation as a Title III Support Officer will not adversly affect your health.
I verify that all information given in this application is true to the best of my ability. I authorize contact of listed references. I understand that misrepresentation or omission of facts requested is cause for non-appointment as a City of Jacksonville volunteer or for termination after appointment.
Signature:
Date:
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The City of Jacksonville encourages persons with disabilities to participate in its programs and activities. Requests for an accommodation should be submitted to the Disabled Services Division within a reasonable amount of time by contacting:
Kevin McDaniel
904-630-4940 (Phone)
904-630-4933 (TTY)
bmeyer@coj.net
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