Application

*Full Name (First, Last and Middle) 
*Phone Number 
*Email 

Primary Emergency Contact

*First and Last Name 
*Phone Number 
*Relationship 

Secondary Emergency Contact

*First and Last Name 
*Phone Number 
*Relationship 

*Dates you would like to volunteer  
*Timeframe Available 
*Occasionally, the City may have opportunities for event volunteers on dates other than those listed above. Are you amenable to being contacted regarding such opportunities?
 
*Have you ever done volunteer work before?
 
If yes, for whom?
Please list any past experience or education related to volunteering at events.
*The volunteer positions at events occur outside and may involve: lifting, standing/ walking for long periods of time and may involve exposure to dust, pollen, animal hair, UV rays and other potential irritants. Do you feel you can do the volunteer work with or without reasonable accommodations?
 
What accommodations or limitations should apply to the volunteer work?
*Why do you wish to volunteer at Centennial's events? 
Please list any other information you feel is pertinent about yourself or volunteer experience.
*By checking this box I certify that my statements in this application are true and correct to the best of my knowledge and are made in good faith.  

Background Check Disclosure and Authorization

In the interest of maintaining the safety and security of our citizens, employees, and property, the City of Centennial (the “City”) will order a “consumer report” (a background report) on you in connection with your volunteer application, and if you are selected, or if you already volunteer for the City, may order additional background reports on you for volunteer participation purposes. The background check company, ADP Screening and Selection Services, will prepare the background report for the City. ADP Screening and Selection Services is located at 301 Remington Street, Fort Collins, CO, 80524, and can be reached at 800-367-5933. The background report may contain information concerning your character, general reputation, personal characteristics, mode of living, and credit standing. The types of information that may be ordered include but are not limited to: Social Security number verification; criminal, public, educational and, as appropriate, driving records checks; verification of prior employment; reference, licensing and certification checks; credit reports; and drug testing results. The information may be obtained from private and public record sources, including personal interviews with your associates, friends, and neighbors. (An “investigative consumer report” is a background report that includes information from such personal interviews.) The nature and scope of the most common form of investigative consumer report is an investigation into your education and/or employment history conducted by ADP Screening and Selection Services or another outside organization. You may request more information about the nature and scope of an investigative consumer report, if any, by telephoning the City at 303-754-3444. A summary of your rights under the Fair Credit Reporting Act is also being provided to you with this form.

Authorization for Background Checks

After carefully reading this Background Check Disclosure and Authorization form, I authorize the City to order my background report, including investigative consumer reports. I understand that the City may rely on this authorization to order additional background reports, including investigative consumer reports, during my time as a volunteer without asking me for my authorization again as allowed by law. I also authorize the following agencies and entities to disclose to ADP Screening and Selection Services and its agents all information about or concerning me, including but not limited to: my past or present employers; learning institutions, including colleges and universities; law enforcement and all other federal, state and local agencies; federal, state and local courts; the military; credit bureaus; testing facilities; motor vehicle records agencies; all other private and public sector repositories of information; and any other person, organization, or agency with any information about or concerning me. The information that can be disclosed to ADP Screening and Selection Services and its agents includes, but is not limited to, information concerning my employment history, earnings history, education, credit history, motor vehicle history, criminal history, military service, professional credentials and licenses and substance abuse testing. I agree the City may rely on this authorization to order background reports, including investigative consumer reports, from companies other than ADP Screening and Selection Services without asking me for my authorization again as allowed by law. I also agree that a copy of this form is valid like the signed original. I certify that all of my personal information on this form is true and correct and understand that dishonesty will disqualify me from consideration for volunteering with the City, or if I am selected or already volunteer for the City, that my participation in the volunteer program may be terminated.
*I have read the above and authorize obtaining of such information and agree may rely on this authorization. 

Personal Information for Background Check

Maiden/Other Names
Years Used
*Social Security Number 
*Driver’s License or State Identification Card Number 
*State 

Addresses Within the Past Seven Years

*Present Address 
*City, State, Zip 
*In residence beginning (MM/YY) 

Prior Address
City, State, Zip
Dates In Residence (MM/YY - MM/YY)

Prior Address
City, State, Zip
Dates In Residence (MM/YY - MM/YY)

Prior Address
City, State, Zip
Dates In Residence (MM/YY - MM/YY)

Prior Address
City, State, Zip
Dates In Residence (MM/YY - MM/YY)

Prior Address
City, State, Zip
Dates In Residence (MM/YY - MM/YY)

Prior Address
City, State, Zip
Dates In Residence (MM/YY - MM/YY)

If needed upload document with additional addresses from within the last 7 years.
Upload a file
  

*I certify that all of my personal information on this form is true and correct and understand that dishonesty will disqualify me from consideration for volunteering with the City, or if I am selected or already volunteer for the City, that my participation in the volunteer program may be terminated. 

Quick Contact Info:

City of Centennial
13133 East Arapahoe Road
Centennial, CO  80112

(303) 325-8000 - 24 Hour Citizen Response Center
(720) 488-0933 - Fax Number

 

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