Department of Military Affairs                                                                     1900 Williams Street,                                                                                                                            Helena, MT 59604-4789
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Agency                                                                                     Location 

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Name (Last, First, Mi)                                                              Social Security No.

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Address                                                                                 (Home Telephone Number)


Volunteer Period: Volunteer will begin _________ thru ___________

Volunteer Activity:

 Indicate if activities will include any of the following:

__ Travel
__ Handling Money
__ Driving State vehicle
__ Driving Own Personal Vehicle for State Business

Driver's License No. _________________ Expiration Date: _______________

I will comply with all policies, procedures, rules, regulations, directive and instructions provided by the volunteer coordinator. By entering into this agreement, I understand that I will be covered by Worker's Compensation insurance and will not receive salary or wages. I will conduct myself in accordance with those standards set forth for regular department employees. I understand and agree to the following policies and conditions.

If a volunteer operates a private motor vehicle as part of his/her volunteer activities, he/she must provide a copy of their certification of insurance coverage.

 
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Volunteer Signature                                              Supervisor Signature


Date___________________                              Date___________________