PIEDMONT REGIONAL LIBRARY SYSTEM

990 Washington Street, Jefferson, GA 30549

706.367.9399

prlib.org

VOLUNTEER APPLICATION

Thank you for volunteering to share your talents, skills and time with the Piedmont Regional Library System. Please take a few minutes to complete this application.

Name:
Last	First
Address:
Street	City	Zip Code
Phone:	Email:
Occupation:

Library Location

☐	Auburn	☐	Banks County	☐	Braselton	☐	Commerce
☐	Jefferson	☐	Maysville	☐	Nicholson	☐	Statham
☐	Talmo	☐	Winder	☐	Regional Office

Briefly explain why you would like to work at the library:

List previous volunteer experience:

Any physical challenges we should be aware of:

Please list any special skills or interests:

Are you required to perform volunteer service?	☐	Yes	☐	No
Hours Required:	Completion Date:
Name, title, phone and email of the person to whom you report your hours:

Emergency Contact:
Phone:

Please check the times you are available to volunteer.

MORNING	AFTERNOON	EVENING
9 AM – 12 NOON	12 NOON – 5 PM	5 PM – 9 PM
MONDAY	☐	☐	☐
TUESDAY	☐	☐	☐
WEDNESDAY	☐	☐	☐
THURSDAY	☐	☐	☐
FRIDAY	☐	☐	☐
SATURDAY	☐	☐	☐

Date you would like to begin:

Signature:

Signature of Parent if volunteer is 17 or younger:

Date: