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Informed Consent - Volunteer

  1. Informed Consent - Volunteer
    Please complete the items below to be considered as a volunteer in/for a program sponsored by the City of Winona. Please contact Amy Karsten at or (507)457-8291 with any questions regarding requested information.
  2. Terms of Volunteer Arrangement
    Should you accept a volunteer arrangement with the City of Winona (City), you retain the right to resign, with or without notice. The City reserves the same right with respect to termination of this arrangement. Your volunteer arrangement is for no definite term, regardless of any other oral or written statement by any company officer or representative, with the exception of an expressed written contract signed by the City Manager.
  3. We look forward to the contributions you will make to the City of Winona and for the professional and personal opportunities we will provide for you!
  4. Check box below to accept volunteer arrangement.*
  5. I authorize the Minnesota Bureau of Criminal Apprehension to disclose all criminal history information to the City manager for the purpose of employment with the City of Winona, Minnesota. This authorization shall be valid for a period of one year, but I reserve the right to cancel this authorization at any time prior to its expiration by providing written notice to the City Manager of the City of Winona, Minnesota.
  6. I understand that the Winona Police Department will secure my criminal history by retrieving and reviewing data maintained by the Minnesota Bureau of Criminal Apprehension Computerized Criminal History Information system. If I have resided in Minnesota for less than five years, I hereby authorize the Winona Police Department to also conduct a search of the national criminal records repository including the criminal justice data communication network.
  7. I understand that I will receive a copy of the criminal history information and shall have the right to challenge the accuracy of completeness of the information contained in the report under Minnesota Statutes Section 13.04, Subd. 4.
  8. Having been informed of and understanding my right, I hereby authorize and agree to allow the City of Winona to obtain my criminal history information.
  9. I have resided in Minnesota for the past five years?*
  10. If college student, enter permanent address)
  11. MM/DD/YYYY format
  12. If none, type none
  13. Electronic Signature Agreement*
    By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.
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  15. This field is not part of the form submission.