From:  Hiring Department/Office   ________________________________________

Subject: VOLUNTEER SERVICES
___________________________________________________________________________________

This is to acknowledge that the following person desires to volunteer his/her services to San Francisco State University for no compensation.
 

____________________________     _____________________________      __________________
Last Name                                                 First Name                                         Middle Initial

_____________________________________________________________  __________________
Address    City  State  Zip Code                                                                          Telephone No.

Date of Birth: ________________ Are you a SFSU  __ Faculty  __  Staff  __ Student  (Check one)

____________________________     _____________________________     __________________
Emergency Contact Person’s Name    Address                                                Telephone No.

Is a driver’s license required as part of volunteer responsibilities (Check one)  __ Yes  __ No

Is travel required as part of volunteer responsibilities requiring reimbursement?
(Check one) __ Yes  __ No

If a driver’s license is required and/or the person is to receive reimbursement for travel expenses, then please provide the Social Security No.:____________________________________

Effective date of Volunteer Services: _________________   End date of Services: _________________

____________________________     _____________________________     __________________
Director’s/Supervisor’s name              Department                                            Telephone No./Ext.

Brief Description of Essential Functions:
 
 
 

Identify Required Licenses, Certifications, etc:  _________________    Expiration Date: _____________

______________________________________      _______________________________________
Volunteer’s Signature/Date                                       Supervisor’s Signature/Date

______________________________________________________      __________________________
Human Resources Representative/Designee Signature                         Date