Community Service Application

Contact Information

Email *

Phone Number *

Person to contact in the event of an emergency

Name *

Phone Number *

Relationship *

Court Information

Name of Presiding Judge

District

Municipality

Case Information

Case Number *

Hours Needed *

Due Date *

Description of Charge/Offense

Availability. Please check all that apply.

Tuesdays 9:00 AM-12:00 PM

Tuesdays 1:00 PM-4:00 PM

Wednesdays 9:00 AM-12:00 PM

Wednesdays 1:00 PM-4:00 PM

Thursdays 9:00 AM-12:00 PM

Thursdays 1:00 PM-4:00 PM

Saturdays 9:00 AM-12:00 PM

Volunteer opportunities available through the Department of Public Works can be physically demanding. Reasonable accommodations will be made to enable individuals with disabilities to perform the essential functions. Please describe any physical restrictions or limitations you may have that could hinder job performance.

Please place a check mark next to each statement after reading.

Work assignments must be scheduled in advance with the Public Works volunteer coordinator by calling/texting 801-310-6283

I understand that if I am unable to show up for a scheduled work assignment for any reason, I am to notify the volunteer coordinator as soon as possible. I understand that if I miss my scheduled date and time of service without prior notification, my volunteer opportunity may be terminated.

I understand that I am responsible for providing my own transportation to and from each job site.

I understand that I am required to show up wearing the proper attire: full-length pants, shirt with sleeves (no tank tops or other revealing attire), shoes that completely cover the toes, work gloves, and eye protection. I also understand that I may be exposed to inclement weather conditions and will need to plan accordingly.

I understand that non-emergency cell phone use, including sending/receiving text messages, is restricted while performing work assignments. Failure to comply will result in termination of volunteer opportunity. Warnings will not be issued.

I understand that I should treat my assignments as seriously as I would a paid job. I need to show up on time ready to work. I also need to treat other workers and the public with respect and dignity.

I fully understand and agree to assume all risks involved in any and all duties that I perform for the City of Orem. Such duties may consist of, but are not limited to, the use of manual tools and gas-powered equipment, work along roadways, custodial duties, and other duties as assigned.

I have read and understand the above rules and agree to abide by them.

Please read through and sign the agreement below if you are over the age of 18. If you are under the age of 18, please have a parent/legal guardian read through and sign the agreement on your behalf.

Volunteer Agreement

I represent to the City of Orem ("City") that I am fully authorized to sign for and bind the undersigned volunteer ("Volunteer") regarding participation in court-appointed community service. On behalf of the Volunteer, I agree to comply with all rules prescribed by the City as deemed necessary for the efficient and safe conduct of court-appointed community service and related activities. I agree to conduct myself in a proper, appropriate manner during court-appointed community service and related activities and to not engage in any activity that is dangerous or likely to cause harm, injury or damage to the person or property of others.

RIGHT OF TERMINATION: I understand that the City reserves the right to restrict or reject my participation without liability to the City. Any employee of the City may exercise this right at any point in time, before or during the court-appointed community service, for any reason considered by the City to be inconsistent with the goals, values, and objectives of the City of Orem.

INDEMNIFICATION: As a condition of being a participant in court-appointed community service, I agree to assume full responsibility for my conduct and to indemnify and hold the City of Orem and their respective officers, officials, employees, representatives, volunteers and agents; and all others having any responsibility therefore, harmless from any liability, claim, loss or expense (including attorney's fees) caused by or arising from (a) any conduct or negligence by me (b) any act of any court-appointed community service participant or spectator (c) any infringement or violation by me of the rights of others.

I understand that the City reserves the right to screen volunteer applicants and will place applicants in specific locations and positions based on the needs of the City. I understand that I will not be paid for my services as a volunteer, and I am giving my time freely to perform court-appointed community service.

I understand that submitting this volunteer application does not automatically guarantee my participation in court-appointed community service with the City, and that I will be notified in writing of such acceptance.

I have read and agree to the rules.

Applicant's Signature

First Name

Last Name

Choose how to sign

Draw Type

I agree to electronically sign and to create a legally binding contract between the other party and myself, or the entity I am authorized to represent.