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Weber County Sheriff's Office
Weber County Home
Weber County Volunteer Application
Volunteering For:
VIPS
Chaplain
Name
Address
Phone Number
Email
*** Must be 21 years of age or older to apply. ***
Have you ever been arrested or charged with any criminal violation in any jurisdiction?
YES
NO
If Yes please give a detailed explanation:
Can you perform the Volunteer duties of this volunteer position without special accommodations for a disability or health concern:
(Answering NO does not automatically disqualify you for volunteer status.)
YES
NO
Emergency Contact Name
Emergency Contact Phone
Relationship to Applicant
I hereby certify that all information made in this application is true. I understand that I am required to abide by all rules and regulations, police and procedures of Weber County Corporation and Weber County Sheriff's office. Further, I hereby grant my permission to have any information, including criminal history information obtained, to be discussed with the Volunteers In Police Service, Executive Board to determine my eligibility for the program.
Signature
Date:
If I am accepted as a Weber County volunteer, I agree to perform the volunteer duties as specified on my selected Volunteer Duties description, to the best of my ability and in a professional manner. I will appreciate constructive feedback. If problems arise such as scheduling, I will notify my supervisor as soon as possible before my assigned shift.
CONFIDENTIALITY: I agree to maintain the same strict confidentiality in the performance of my volunteer duties that is expected of the paid staff. RELEASE: While performing volunteer assignments and duties, the undersigned volunteer (unsalaried worker), authorized by the Division Director, shall be deemed an employee of Weber County only to the extent provided for under the Utah Volunteer Governmental Workers Act, U.C.A. 67-20-101 et seq., which provides the following protections: A. Medical Benefits under Worker's Compensation for any injury sustained while engaged in performance of any service; B. Properly licensed operation of County vehicles or equipment; C. Liability protection normally afforded salaried employees. If I, as a Weber County volunteer, sustain injury, cause injury to another person, or damage county property or property of another person while performing volunteer duties, I shall immediately report such injury or damage to my volunteer supervisor and cooperate fully with Weber County Attorney's Office in reporting and investigating such claims. With this knowledge, the undersigned volunteer hereby releases Weber County, its agents and employees from any liability or obligation arising from, or in connection with, the undersigned's Volunteer Activities with Weber County other than stated above.
I have read and understand the above conditions.
(Initial)
Volunteer Signature:
Date:
Please complete the reCAPTCH before submitting the form.