Volunteer Driver Application
Thank you for your interest in volunteering for Mead Public Library to deliver books to the homebound. Please complete the below application. By completing this application, you authorize Mead Public Library to conduct a background check. Note, you will be asked to provide 1) Proof of insurance and 2) Drivers License. If you have any questions about volunteering, please contact Pattie Pilz, Volunteer Coordinator at 920-459-3400 ext. 2039.
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Email *
Legal First Name *
Middle Name
Last Name *
Maiden Name (If applicable)
Phone *
Birthdate *
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Do you speak a language other than English?  If so, please tell us.
Select the cities you are willing to deliver to. *
Required
Driver's License Number *
License Expiration Date *
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If your vehicle comprehensively insured? *
Have you been involved (as a driver) in any VEHICLE ACCIDENT in the past 5 years?
If yes, please provide details. *
Have you been convicted of any MOVING TRAFFIC VIOLATION in the past 5 years? 
If yes, please provide details. *
#1 Reference - Name and Phone 
#2 Reference - Name and Phone 

As a volunteer, you agree to indemnify, defend and hold harmless and release Mead Public Library, City of Sheboygan, Mead Public Library Foundation, Inc., Friends of Mead Public Library and their elected and appointed officials, officers, employees and authorized representatives from and against any and all liability, loss, damage, expenses, costs (including attorney's fees) arising out of or in any way attributed to the volunteer activities performed whether on or off library premises.

You acknowledge that you have read it in its entirety, have given the terms due consideration, understand the terms, and understand that you are freely and voluntarily giving up certain rights. You acknowledge that this agreement shall be binding upon all of your successors, heirs, assigns, receivers and the like. It indicates your approval to allow Mead Public Library designee to contact references or employers related to service as a library volunteer. You agree to allow Mead Public Library designee to conduct a yearly background check related to your service as a volunteer. A background check is required for all adult volunteers of Mead Public Library.

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By checking this box, you agree to abide by Mead's confidentiality policy. You agree to not discuss any patron's living conditions, health concerns or financial status with anyone other than a Mead employee. You agree to not copy or reproduce information concerning any patron.  And, you agree not to solicit business or leave any promotional materials with patrons. *
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