OPNAVINST 1750.1E
27 Jun 05
Enclosure (14)
FOR OFFICIAL USE ONLY (When Filled In)
V OLUNTEER AGREEMEN T FOR
PRIVACY ACT STATEMENT
AUTHORITY: Section 1588 of Title 10, U.S. Code, and E.O. 9397.
PRIN C IPA L PU RPOSE(S): To document voluntary services provided by an individual, including the hours of service performed, and to
obtain agreement from the volunteer on the conditions for accepting the performance of voluntary service.
ROUTINE USE(S): None.
DISCLOSURE: Voluntary; how ever failure to complete the form may result in an inability to accept voluntary services or an inability to
document the type of voluntary services and hours performed.
PA RT I - GEN ERA L INFO RM A T IO N
5. ORGANIZATION/UNIT WHERE SERVICE OCCURS4. INSTALLATION
7. ANTICIPATED DAYS OF WEEK6 . PROGRA M W H ERE SERVIC E OC C U RS
9 . D ESC RIPTION OF V OLU N TEER SERV IC ES
I expressly agree that my services are being provided as a volunteer and that I w ill not be an employee of the United States
Government or any instrumentality thereof, except for certain purposes relating to compensation for injuries occurring during the
performance of approved volunteer services, tort claims, the Privacy Act, criminal conflicts of interest, and defense of certain suits arising
out of legal malpractice. I expressly agree that I am neither entitled to nor expect any present or future salary, w ages, or other benefits
for these voluntary services. I agree to be bound by the laws and regulations applicable to voluntary service providers and agree to
participate in any training required by the installation or unit in order for me to perform the voluntary services that I am offering. I agree
to follow all rules and procedures of the installation or unit that apply to the voluntary services I w ill be providing.
1. TYPED NAME OF VOLUNTEER (Last, Firs t, M iddle Initial)
a. SIGNATURE OF VOLUNTEER b. D A TE SIGN ED (Y YYY M M D D )
2. SSN 3. DATE OF BIRTH (Y YYY M M D D )
11.a. TYPED NAME OF ACCEPTING OFFICIAL
(Last, Firs t, M iddle Initial)
b. SIGN A T U RE c. DATE SIGNED (Y YYY M M D D )
PART IV - TO BE COMPLETED AT END OF VOLUNTEER'S SERVICE BY VOLUNTEER SUPERVISOR
14. AMOUNT OF VOLUNTEER TIME DONATED
a. YEA RS (2 ,0 8 7
hours= 1 year)
b. W EEKS c. DAYS d. H O U RS
15. SIGNATURE 16. TERMINATION DATE
(Y YYYM M D D)
17.a. TYPED NAME OF SUPERVISOR
(Last, Firs t, M iddle Initial)
b. SIGN A T U RE c. DATE SIGNED (Y YYY M M D D )
DD FORM 2793, FEB 2002
Exception to Standard Form 50 granted by
Office of Personnel Management (OPM) w aiver.
APPROPRIATED FUND ACTIVITIES NONAPPROPRIATED FUND INSTRUMENTALITIES
8. ANTICIPATED HOURS
1 0 . C ERTIFICATION
PART III - VOLUNTEER IN NONAPPROPRIATED FUND INSTRUMENTALITIES
I expressly agree that my services are being provided as a volunteer and that I w ill not be an employee of the United States
Government or any instrumentality thereof, except for certain purposes relating to compensation for injuries occurring during the
performance of approved volunteer services and liability for tort claims as specified in 10 U.S.C. Section 1588(d)(2). I expressly agree
that I am neither entitled to nor expect any present or future salary, w ages, or other benefits for these voluntary services. I agree to be
bound by the laws and regulations applicable to voluntary service providers, and agree to participate in any training required by the
installation or unit in order for me to perform the voluntary services that I am offering. I agree to follow all rules and procedures of the
installation or unit that apply to the voluntary services that I am offering.
13.a. TYPED NAME OF ACCEPTING OFFICIAL
(La st, First, M iddle Initial)
a. SIGNATURE OF VOLUNTEER b. D A TE SIGN ED (YYYYMMDD)
1 2 . C ERTIFICATION
b. SIGN A T U RE c. DATE SIGN ED (YYYYMMDD)
PA RT II - VOLU N TEER IN A PPROPRIA T ED FU N D A CT IV IT IES
PREV IO U S EDIT ION IS O BSO LET E.