OMB Control Number 1093-0006
Expiration Date: 10/31/2024
VOLUNTEER SERVICE APPLICATION |
||||||||||||||||||
This optional application helps federal land and water management agencies identify interested and qualified candidates for available volunteer positions. Applications are submitted and processed locally for each position. If a volunteer commits to a specific volunteer activity, they are required to complete an OF-301a Volunteer Service Agreement. Mark X in the appropriate boxes and print or type all responses. |
||||||||||||||||||
1. Name (Last, First) |
2. Date of Birth / / |
3. Telephone Number ( ) - |
4. Email Address |
|
||||||||||||||
5. Street Address, Apt. # |
6. City |
7. State |
8. ZIP code |
|
||||||||||||||
9. 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) |
||||||||||||||||
10. 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) |
||||||||||||||||
11. What languages are you proficient in? Check all that apply. |
||||||||||||||||||
Arabic Chinese English French
|
German Hindi Japanese Korean
|
Lahanda/Punjabi Portuguese Russian Spanish Other (Please specify) |
||||||||||||||||
12. If you have a specific volunteer interest, please identify and describe your qualifications, skills, experiences, or education that may apply. |
||||||||||||||||||
13. Are you a United States Citizen or Permanent Resident? Yes, I am a U.S. Citizen or Permanent Resident No, I am not a US Citizen or Permanent Resident (if applicable, list visa type ) |
||||||||||||||||||
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. |
||||||||||||||||||
|
||||||||||||||||||
|
||||||||||||||||||
|
||||||||||||||||||
18a. Which months are you available to volunteer? Check all that apply. |
||||||||||||||||||
January July |
February August |
March September |
April October |
May November |
June December |
|||||||||||||
18b. How many hours per week would you be available for volunteer work? Hours 18c. Which days are you available to volunteer? Check all that apply. Monday Tuesday Wednesday Thursday Friday Saturday Sunday |
||||||||||||||||||
|
||||||||||||||||||
I will furnish my own lodging I will require assistance in finding lodging |
||||||||||||||||||
Yes No (Please specify) |
||||||||||||||||||
|
||||||||||||||||||
Burden Statement Completing this form is voluntary, but failure to provide the information will prevent program participation. 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 1093-0006. 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 the Interior (USDOI), U.S. Department of Agriculture (USDA), U.S. Department of Defense (USDOD), and U.S. Department of Commerce (USDOC) are equal opportunity providers and employers and 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 of communication of program information should contact the volunteer program to which they are applying. If you would like to file a Section 508-related complaint, please contact the DOI Section 508 Program via email at section508@ios.doi.gov or phone (202) 208-1530. |
||||||||||||||||||
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) they 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
INTERIOR/DOI–05 Interior Volunteer Services File System
(which may be viewed at https://www.doi.gov/privacy/doi-notices)
and OPM/GOVT–1 General Personnel Records (which may be
viewed at
https://www.opm.gov/information-management/privacy-policy/#url=SORNs)
and is consistent with the provisions of 5 U.S.C. 552a (Privacy
Act of 1974), which authorizes acceptance of the information
requested on this form. The information is used to identify
persons interested in participating in a government volunteer
program, managing the volunteer program, including tort claims
and injury compensation. Records or information contained in
this system may be disclosed outside the agencies participating
in this program as a routine use pursuant to 5 U.S.C. 552a(b).
Completing this form is voluntary, but failure to provide the
information will prevent program participation |
||||||||||||||||||
|
24. Date
|
Volunteer Service Application OF301 USDOI – USDA – USDOC - USDOD
File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
Author | PCxx |
File Modified | 0000-00-00 |
File Created | 2024-09-05 |