Pine View Farm Fun
874 Plunkert Road
Littlestown, PA 17340
717-359-0070 Office #
717-359-8004 Fax #
www.pineviewfarmfun.com
pineviewfarmls@embarqmail.com
Volunteer Application
Date of Application:______________________________
Application must be completed in full. All applicants must be at least 18 years or older. Please
Print Your Answers. Mail to the above address or fax.
Name:___________________________________________________________________________________________________________
First
Middle
Last
Address:_________________________________________________________________________________________________________
House # and Street Name
P.O. Box or Apt #
City:_______________________________________________State:_______________________________Zip:_______________________
Phone:_____________________________________________Cell Phone:____________________________________________________
Email:___________________________________________________________________________________________________________
Emergency Contact:_______________________________________________________________________________________________
Name
Number
Relationship to you
Any Allergies?__________Yes___________No If “Yes” please list allergies:_________________________________________________
_______________________________________________________________________________________________________________
Any medical conditions or health issues we should be aware of; for your safety and ours: _______________________________________
_______________________________________________________________________________________________________________
*In order to better match a volunteer experience here at the Farm and for you, please tell us about yourself. All
applications and records are kept confidential.
It is necessary to be 18 years of age to volunteer: _________Yes __________No
Your Current Age:_______________________
If under the age of 18…what is this volunteer work being done for: _________Scouts _________ School ________ Project________Other
Please Explain your volunteer purpose:________________________________________________________________________________
________________________________________________________________________________________________________________
If you are volunteering for service hours in order to graduate, or for a senior project, what school do you attend?__________________
________________________________________________________________________________________________________________
Person to Contact regarding your project:_____________________________________________Phone:___________________________
Please circle all that apply or interest you
Tour Guide
Special Events
Group Trips
Talks & Presentations
Building Exhibits
Café/Gift Shop
Cleaning/Maintenance
Landscaping
Petting Zoo
Other
Please circle volunteer shift times you are interested in
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
9:00am-12:00pm
9:00am-12:00pm
9:00am-12:00pm
9:00am-12:00pm
9:00am-12:00pm
9:00am-12:00pm
9:00am-12:00pm
1:00pm-4:00pm
1:00pm-4:00pm
1:00pm-4:00pm
1:00pm-4:00pm
1:00pm-4:00pm
1:00pm-4:00pm
1:00pm-4:00pm
Do you have a current Tetanus Shot:________Yes________No
Date Given:_______________________________________________
Why are you interested in being a volunteer at Pine View Farm Fun? ________________________________________________________
_________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________
Do you have any volunteer experience? __________Yes________No
If Yes please explain:__________________________________
________________________________________________________________________________________________________________
________________________________________________________________________________________________________________
Do you have any special talents, skills, interests, or licenses?______________________________________________________________
________________________________________________________________________________________________________________
________________________________________________________________________________________________________________
Have you ever volunteered at Pine View Farm Fun before?___________Yes ___________No
If Yes please tell us when:___________
________________________________________________________________________________________________________________
Are you affiliated with any other animal related organizations ?___________Yes__________No
If Yes please list those other organizations:____________________________________________________________________________
________________________________________________________________________________________________________________
________________________________________________________________________________________________________________
What are your strengths?___________________________________________________________________________________________
________________________________________________________________________________________________________________
________________________________________________________________________________________________________________
What are you weaknesses?_________________________________________________________________________________________
________________________________________________________________________________________________________________
General Background Information
You must give complete truthful answers to all questions. If you answer “Yes” to any question, you must list all offenses, and
each conviction, provide date of conviction and disposition, regardless of location of occurrence. Conviction of a criminal offense
is not to bar to employment/volunteer in all cases. Each case is considered on it’s merits. Your answers will be verifired with
appropriate records.
Criminal Offense includes felonies, misdemeanors, summary offenses and convictions resulting from a plea of “no contest”.
Conviction is an adjudication of guilt and includes determination before a court, a district justice, or a magistrate, which results
in a fine, sentence, or probation.
You may omit: minor traffic violations, offenses committed before your 18 th birthday which were an adjudication in juvenile
court or under a Youth Offender Law, and any convictions which have been expunged by a court or for which you successfully
completed and Accelerated Rehabilitative Disposition Program.
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Were you ever convicted of a criminal offense? _____________Yes_____________No
Were you ever convicted of a felony? ____________Yes_____________No
Were you ever convicted of a misdemeanor ?________________Yes_____________No
Were you ever convicted of a crime involving a minor child under the age of 18 ?____________Yes ___________No
Have you ever forfeited bond or collateral in connection to a criminal offense ?______________Yes___________No
Within the last ten years, have you ever been fired from your job for any reason? ___________Yes___________No
Within the last ten years, have you ever quit a job after being notified that you would be fired ?_______Yes________No
Are you subject to any visa or immigration status, which would prevent lawful employment ?__________Yes________No
If you answered “YES” to any of the above questions, please provide a detailed written explanation below :__________________
________________________________________________________________________________________________________________
________________________________________________________________________________________________________________
________________________________________________________________________________________________________________
By signing below I understand that volunteers must be at least 18 years of older and that an interview, background check, and
orientation training class must be completed before I am eligible for acceptance to the Pine View Farm Fun Volunteer Program. I
agree to submit and pay for a background check, pay for my required volunteer uniform shirt at a current cost of $20 per shirt. I
authorize Pine View Farm Fun LLC to take any steps to insure my health in and emergency. I authorize Pine View Farm Fun LLC to
use my name and/or photos for public relations and advertising purposes related to the Farm. I understand that due to the
nature of this Volunteer Program I must exercise caution at all times. I am participating at my own risk, and will not hold Pine
View Farm Fun LLC or it’s representatives, or any other persons, animals, or environments responsible in the event of an
accident, injury, or death. I freely volunteer my own time at my own risk.
Signature:________________________________________________________________Date:___________________________________
Print Name:______________________________________________________________
If under the age of 18, parent or guardian signature is required.
Parent/Guardian Signature:_________________________________________________Date:___________________________________
Print Name:______________________________________________________________Relationship:_____________________________
For Office Staff Only to complete below
Date Interviewed:______________________By Who:____________________________Hired:____________Yes____________No