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Volunteer Services
614 Division Street MS-4  Port Orchard, WA
Phone:(360)337-4650 * Fax:(360)337-7052
 
The following information will assist us in the selection process for appointment to a Kitsap County Board, Commission, Committee or Council.  Please help us to get to know you.

Application for Appointment to a Board, Commission, Committee, Council or Task Force

PERSONAL INFORMATION

Name: 

Address: 

City: 

State: 

Zip: 
 


 

Home Address: 
(if different)  

Primary Phone: 

Work Phone:

Primary E-Mail: 

Work E-Mail: 

Occupation: 

Employer: 


Business Address:

Education: 

I would like to be considered for:

Why are you applying for this appointment? 

Which of your personal interests prompted you to apply for this appointment?

Have you served on any other Kitsap County board, commission, committee, council or task force? If yes, please list: 

Please list your qualifications for this appointment (include skills, activities, training, education):

What are your community interests (committees, organizations, special activities) ?

 
Personal References:
*Please provide the names of two non-relative references

Name: 

Phone: 

Address: 

City: 

State: 

Zip: 

Relationship: 

Name: 

Phone: 

Address: 

City: 

State: 

Zip: 

Relationship: 

I hereby certify that the information on this application is true and complete. I authorize Kitsap County Volunteer Services to verify any of the information on this application and to secure information deemed necessary from employers and personal references in order to determine my suitability for the volunteer position I am seeking with Kitsap County.

I also understand as a Kitsap County volunteer I will be performing services for civic, charitable or humanitarian reasons, or to complete requirements for certifications or to improve employment opportunities; I have not been promised and have no expectation of compensation for services rendered; and offer my services freely and without pressure or coercion, direct or implied, from the County.

I hereby release Kitsap County, its employees, officers, directors, and agents from any claims, lawsuits, or actions I, my heirs, or legal representatives may have for any personal injury and/or property damage I may incur as a result of my voluntary services except those damages caused by the sole negligence or willful misconduct of Kitsap County employees. I understand that, but for this release of any and all liability, the County would not accept my offer of volunteering service.

I HAVE READ AND VOLUNTARILY SIGN THIS AGREEMENT AND RELEASE OF LIABILITY.

Signature: 

Date: 

After pressing submit, you should see a confirmation page listing your responses.  If this page does not appear or if you have any other difficulty with this form, please contact Rebecca Pirtle (360) 337-4650 or rpirtle@co.kitsap.wa.us.

Last Updated:  April 21, 2016
Contact Rebecca Pirtle, Volunteer Services Coordinator,
at (360) 337-4650
Volunteer
Current Opportunities Updated 
Volunteer Application Form
Application for Appointment to a Board, Council or Commission
Volunteer Recognition
Hours: 8:30 - 4:30
Monday-Thursday