Lester Public Library of Rome

1157 Rome Center Dr., Nekoosa, Wisconsin 54457
(715) 325-8990 · Fax (715) 325-8993 · TTY 711 · Email: romelib@wctc.net

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Library info

Open hours
Mon, Wed, Fri: 10am-5pm
Tues, Thurs: 10am-7pm
Sat: 9am-2pm
Sun: closed

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South Central Library System

Teen Volunteer Application Form

* indicates required information.

Contact Information

Your name *

Address: *

City: *

State: *

Zip: *

Age: * Under 14
14-17
18-19

Emergency Contact: *

References

Give two personal references we could call and talk to about your abilities (teachers, counselors or other adults not related to you).

Reference #1 Name: *

Reference #1 Phone: *

Reference #1 Position:

Reference #2 Name: *

Reference #2 Phone: *

Reference #2 Position:

Volunteer Experience

Have you volunteered before? * Yes
No

Please list the skills and experience that you possess which can be utilized in your volunteer services at the library. *

Why do you think you want to volunteer at the library? *

Please list any interests, hobbies, clubs, activities or special skills: *

Schedule

Are you required to fulfill a specific number of volunteer hours? * No
Yes

How many? *

First day you can volunteer: *

Last day you can volunteer: *

Check 2 shifts (not back to back): * Monday 10-1
Monday 1-4
Tuesday 10-1
Tuesday 1-4
Tuesday 4-7
Wednesday 10-1
Wednesday 1-4
Thursday 10-1
Thursday 1-4
Thursday 4-7
Friday 10-1
Friday 1-4
Saturday 9-12

List any days you will not be able to volunteer for special reasons:

Permission

Parent/Guardian Name (required if teen is under age 18): *

Approve: * Yes
No

I attest that all information above is accurate and true to the best of my knowledge: * Yes
No

Today's Date: *

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