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2. Learning Lab Instructor Registration Form
   This information is confidential and will be kept in the Billings Public Library Learning Lab database so that our staff knows what you are able to teach. When teens express an interest in a topic you list, you will be contacted to schedule a workshop or a series. We utilize background checks for all people working with minors. When we run the background check, we will contact you to request your Social Security Number.
4. First Name*
5. Middle Initial
6. Last Name*
8. Address*
10. City*
11. State*
12. Zip Code*
14. Home Phone Number*
15. Cell Phone Number
17. Email Address*
18. Date of Application*
    Date of Application
20. Current Employer*
21. Work Phone
23. Please list other names, if any, used on employment or education records.
25. Emergency Contact*
26. Emergency Contact Phone*
28. Please list specific technology or art that you would be willing to teach in the Learning Lab now or in the future. (This may include but is not limited to writing, knitting, drawing, photography, software, music, engineering, programming)*
30. How many students would you be comfortable teaching?*

    1. 1-6
    2. 7-12
    3. 13-20

    1. 21-50
    2. 51+
31. Is there a time of year that is best for you to teach? Check all that apply.*

    1. January - May
    2. June - August
    3. September - December
33. What time of day are you available to teach?*

    1. Morning
    2. Afternoon
    3. Evening
34. Have you ever been arrested and / or convicted of a crime?*

    1. Yes
    2. No
36. If yes, for what?
37. Where?
38. When?
40. Please read the following and indicate "yes" or "no".
42. As an applicant for a volunteer position with Billings Public Library, I hereby expressly authorize release of any information a reference may have concerning me, including information of a confidential or privileged nature. I hereby release any organization, company, institution or person furnishing the information requested. I authorize the use of duplicated copies of this form to serve as the original.*

    1. Yes

    1. No
44. For the purpose of in-house security, I consent to a criminal history check, background investigation and drug screening prior to volunteering.*

    1. Yes

    1. No
46. I certify that the foregoing answers and all supplemental documents are correct and that false information may result in denial and/or dismissal. If offered a volunteer position, I will abide by the Policies, Practices and Procedures of Billings Public Library and the City of Billings.*

    1. Yes

    1. No
48. Do you have any comments, questions or clarifications? Please add them here.
50. How did you learn about the lab and this volunteer opportunity?
52. Billings Public Library reserves the right to refuse services based on objective criteria other than the following: gender, race, religion, sexual orientation, and familial status.
Leave This Blank:


54. 1. Receive an email copy of this form.
55. Email address

    This field is not part of the form submission.

56. Submit

* indicates a required field