Human Resource Services	HUMAN RESOURCE SERVICES TEL NO: (818) 677-2101 FAX NO: (818) 677-7863 MAIL DROP: 8229
	CSUN Volunteer Identification Form

LAST NAME:

FIRST NAME:

M.I.:

DATE OF BIRTH:

ADDRESS:	CITY, STATE, ZIP:	PHONE:
DEPARTMENT:	SUPERVISOR'S NAME:	PHONE/EXT:

EMERGENCY CONTACT:			EMERGENCY PHONE:
VOLUNTEER DATES:	START:	END:
ASSIGNMENT AND SUMMARY OF DUTIES: (Maximum 3 Lines)

1.	IS A PROFESSIONAL LICENSE OR CERTIFICATE REQUIRED TO PERFORM THESE DUTIES? (If yes, please provide a copy of the required document)	YES	NO
2.	WILL YOU NEED TO DRIVE A VEHICLE ON UNIVERSITY BUSINESS? (If yes, please provide driver's license number and expiration date)	YES	NO
	ATTACH A COPY OF CA DRIVER'S LICENSE AND PROOF OF INSURANCE TO THIS FORM.
	(Complete STD 261 "Authorization to Use Privately Owned Vehicle on State Business")
3.	WILL YOU NEED TO TRAVEL ON UNIVERSITY BUSINESS?	YES	NO
4.	ARE YOU RECEIVING ACADEMIC CREDIT FOR VOLUNTEERING?	YES	NO
5.	ARE YOU A UNIVERSITY STUDENT, STAFF, OR FACULTY MEMBER?	YES	NO
This is to acknowledge that I desire to volunteer my services, performing duties similar to those listed above and that services rendered by me will be at the direction of the above-named supervisor or his/her designee. I understand and accept that I will not be compensated for volunteer service. Further, I understand that I serve at the pleasure of my supervisor. Confidentiality of Records: Information contained in Student, Financial, and Human Resource records for CSUN students, employees, volunteers, alumni, and certain financial records must be maintained in a confidential manner at all times. As a volunteer of an office that has access to records in computer information systems or any other source, you are required to maintain this information in a confidential manner. The unauthorized access to, modification, deletion, or disclosure of information in any such system may compromise the integrity of the system or otherwise violate individual rights to privacy and/or constitute a criminal act. Distribution and/or reproduction of any record or information outside the intended and approved use is strictly prohibited. Illegal access or misuse of this information is punishable by fine and/or imprisonment. Further, university computer systems are for the use of authorized users only.
I acknowledge and agree to the above Confidentiality requirements: __________ (Please initial)

Signature of CSUN Volunteer: ______________________________________			Date: ___________
Approval of Campus Personnel: ______________________________________			Date: ___________

~ For HR Use Only ~
ALTERNATE ID: ______________________________________
Form to be retained in the Human Resource Services office, California State University, Northridge
OHRS 20-64 REVISED 10/2004