Name:      _____________________________________________                 Date:     _____________

Address:  ____________________________________________     Phone (day):   _____________

                _____________________________________________     Phone (eve)    _____________

Why do you wish to volunteer at the Haverhill Public Library?  What do you hope to accomplish by volunteering?
______________________________________________________________________________________________________________ 

______________________________________________________________________________________________________________ 

Do you have any experience?   _____ YES     _____ NO  
If YES, please list the organizations and type of work you did.  Please use the back for additional listings.

______________________________________________________________________________________________________________ 

 ______________________________________________________________________________________________________________ 

List any skills you may have (typing, artwork, writing, etc.)

______________________________________________________________________________________________________________ 

______________________________________________________________________________________________________________ 

Person to contact in case of emergency:
Name: ______________________________________________________      Relationship:    ________________

Phone (day):  ________________________________________________    Phone (evening): ________________

If you are under 18, please have your parent or guardian sign this form
Signature: __________________________________________________              Relationship: ________________

Print Name: _________________________________________________                         Phone: ________________