Form OF-301 Volunteer Service Application for Natural & Cultural Res

OMB 0596-0080 v1

VOLUNTEER SERVICE APPLICATION—NATURAL & CULTURAL RESOURCES

The volunteer application helps public lands officials and potential volunteers determine if there are volunteer opportunities that are a good match for the skills and interests identified. All volunteers are required to complete a volunteer agreement once they have identified and committed to a specific volunteer activity. Mark  in the appropriate boxes and print or type all responses.

1. Name (Last, First, Middle)

     

2. Age

   

3. Telephone Number

(   )     -     

4. Email Address

     

5. Street Address, Apt. #

     

6. City, State, and Zip Code

     

7. Which general categories are you most interested in volunteering? Check all that apply.

Archaeology

Botany

Campground/Site host

Campground maintenance

Construction maintenance

Computers

Conservation education

GIS/GPS

Fish/Wildlife

Historical/Preservation

Pest/Disease control

Minerals/Geology

Natural resources planning

Office/Clerical

Range/Livestock

Research/Librarian

Soil/Watershed

Timber/Fire prevention

Trail maintenance

Tour guide/Interpretation

Visitor information

Other (Please specify)      

8. What qualifications, skills, or experiences do you have that you would like to use as a volunteer? Check all that apply.

Backpacking/Camping

Biology

Boat operation

Carpentry

Clerical/Office machines

Computer programming

Drafting/Graphics

Driver’s license

First aid certificate

Hand/Power tools

Heavy equipment operation

Horses – care/ riding

Landscaping/Reforestation

Land surveying Livestock/Ranching

Map reading or GIS/GPS

Mountaineering

Photography

Public speaking

Research/Librarian

Sign language

Supervision

Other trade skills (Please specify)     

Teaching

Working with people

Writing/Editing

Other (Please specify)      

9. If you have a specific volunteer interest, please identify and describe your qualifications, skills, experiences, or education that may apply.

10. Are you a United States Citizen? Yes No (If no, additional information may be required)

10. a. Have you volunteered before? Yes No

b. If yes, please list the organization where you volunteered with a contact name and phone # or email address, and briefly describe what you did.      

10. Would you like to supervise other volunteers? Yes No

10. What are some of your objectives for volunteering? (Optional)      

10. Please list any physical limitations that may impact your volunteer activities.

     

10. a. Which months are you available to volunteer? Check all that apply.

January

July

February

August

March September

April

October

May

November

June

December

15b. How many hours per week would you be available for volunteer work? Hours    

15c. Which days are you available to volunteer? Check all that apply.

Monday Tuesday Wednesday Thursday Friday Saturday Sunday

10. Specify states or locations where you would like to volunteer.

     

10. Specify your lodging needs:

I will furnish my own lodging (such as tent; camper; own, relative’s, or friend’s place)

I will require assistance in finding lodging

10. If a volunteer assignment is not available at the location specified in box #16, do you want your application forwarded to another location or Federal agency seeking volunteers with your background or interests?

Yes No (Please specify)      

10. How did you hear about this volunteer opportunity? Check all that apply.

Volunteer.gov	Brochure
Other internet or website	Volunteer fair or event
Advertisement	Other (Specify)
Word of mouth (friend, colleague, family member)

Burden Statement

According to the Paperwork Reduction Act of 1995, an agency may not conduct or sponsor, and a person is not required to respond to a collection of information unless it displays a valid OMB control number. The valid OMB control number for this information collection is 0596-0080. The time required to complete this information collection is estimated to average 15 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. The U.S. Department of Agriculture (USDA) and U.S. Department of the Interior prohibit discrimination in all programs and activities on the basis of race, color, national origin, gender, religion, age, disability, political beliefs, sexual orientation, and marital or family status. (Not all prohibited bases apply to all programs.) Persons with disabilities who require alternative means for communication of program information (Braille, large print, audiotape, etc.) should contact USDA’s TARGET Center at 202-720-2600 (voice and TDD). To file a complaint of discrimination, write USDA, Director, Office of Civil Rights, 1400 Independence Avenue, SW, Washington, DC 20250-9410 or call (800) 795-3272 (voice) or (202) 720-6382 (TDD). USDA and USDI are equal opportunity providers and employers.

Notice to Volunteer

Volunteers are NOT considered Federal employees except as otherwise provided by law. Volunteer service is not creditable for leave accrual or any other benefit. However, volunteer service is creditable work experience. By signing this application the volunteer(s) understand(s) s/he may be subject to a reference check, background check, and/or criminal history inquiry.

Privacy Act Statement

Collection and use is covered by Privacy Act System of Records OPM/GOVT-1 and USDA/OP-1, and is consistent with the provisions of 5 USC 552a (Privacy Act of 1974), which authorizes acceptance of the information requested on this form. The data will be used to maintain official records of volunteers of the USDA and USDI for the purposes of tort claims, injury compensation, and other volunteer claims allowed by law. Furnishing this data is voluntary, however if this form is incomplete, enrollment in the program cannot proceed.

10. Signature

21. Date

     

Volunteer Service Application OF301 USDA-USDI-DOC-DOD