The Ambassador Volunteer Program

The Ambassador Volunteer Program
Thank you for your interest in becoming an Ambassador for Fairplex Learning and Development Center.

We accept new applications July – March.
PLEASE READ THIS CAREFULLY BEFORE COMPLETING THIS APPLICATION

This organization does not discriminate in the recruitment and placement of volunteers on the basis of race, color, religion, national origin, sex, marital status and disability, age or veteran status. No questions on this application are intended to secure information to be used in a discriminatory manner. Your completed application will be reviewed carefully but its receipt does not guarantee a volunteer position. This organization agrees to use confidential information for its agreed purpose and to keep all information secure. ALL VOLUNTEER POSITIONS REQUIRE A BACKGROUND CHECK.
Name*

First NameLast Name
Cell/Preferred Phone*
Please enter a valid phone number.
Alternate Phone
Please enter a valid phone number.
Email Address*
example@example.com
If you were referred to the program by a current volunteer, please list his/her name.
Have you ever been convicted of a felony or misdemeanor?*

YesNo
If yes, please describe.
A conviction does not mean you will not be offered a volunteer position. What you were convicted of, the circumstances surrounding the conviction and how long ago the conviction occurred are important considerations in determining your eligibility. Give all the facts so that a fair decision can be made.

EMERGENCY INFORMATION

Please note that hospitals ONLY allow next of kin to make decisions on your behalf.
Emergency Contact*
Relationship*
Contact Number*
Please enter a valid phone number.
Alternate Phone
Please enter a valid phone number.
Any medical problems, allergies, etc. that we should be aware of in the event of an emergency?
Do you have a caregiver?

YesNo
Caregiver's Name

First NameLast Name
Caregiver's Phone Number
Please enter a valid phone number.
*I authorize treatment in the event of a medical emergency. I release The Learning Centers at Fairplex, Los Angeles County Fair Association, County of Los Angeles and its partners from any claim or liability for any injury or illness resulting to myself, not occasioned by any fault or neglect on the part of The Learning Centers at Fairplex, Los Angeles County Fair Association and its partners, while participating in such volunteer activities.*

I acknowledge the above

BACKGROUND DISCLOSURE AND AUTHORIZATION FORM
The Los Angeles County Fair Association (the Company) will procure a consumer report and/or investigative consumer report on you in connection with your volunteer application (including independent contractor assignments, as applicable). These background reports may be obtained at any time after receipt of your authorization and, if you are engaged by the Company, throughout your volunteer participation.

Sterling Screening Direct, a consumer reporting agency, will obtain the report for the Company. Sterling Screening Direct can be reached at (800) 899-2272.

The report may contain information bearing on your character, general reputation, personal characteristics, mode of living and credit standing. The types of information that may be obtained include, but are not limited to: credit reports, social security number verification, criminal records checks, public court records checks, driving records checks, educational records checks, verification of employment positions held, personal and professional references checks, and
licensing and certification checks. The information contained in the report will be obtained from private and/or public record sources, including sources identified by you in your job application or through interviews or correspondence with your past or present coworkers, neighbors, friends, associates, current or former employers, educational institutions or other acquaintances.
First Name*
Full Middle Name*
Please write N/A if you do not have a middle name.
Last Name*
Date of Birth*

MonthDayYear
Date
SSN*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Additional Names Know As
This information is being collected to conduct the background screen on you. It will not be used for any other purpose. Provided to you with this authorization is a Summary of Your Rights Under the Fair Credit Reporting Act in a form prescribed by the Federal Trade Commission. Please do not sign this authorization until you have received and reviewed this summary.
You may request more information about the nature and scope of the background report by contacting the Company.

California, Minnesota, and Oklahoma applicants only: check this box if you request a copy of the report ordered on you.
ADDITIONAL STATE LAW NOTICES

Summary of Your Rights under California Civil Code 1786.22 An investigative consumer reporting agency (“Agency”) will supply files and information that you have a right to inspect during normal business hours and on reasonable notice. All files that Sterling maintains on you will be made available for your visible inspection, as follows:

• In person, if you appear in person and furnish proper identification. A copy of the file will also be available to you for a fee not to exceed the actual costs of copying.

• By certified mail, if you make a written request to, with proper identification, for copies to be sent to a specified address. However, agencies complying with a request for such a mailing will not be liable for disclosures to third parties caused by mishandling of mail after it leaves the Agency.

• A summary of all information contained in your file and required to be provided to you under the California Civil code will be provided by telephone, if you have made a written request, with proper identification.

• “Proper identification” includes documents such as a valid driver’s license, social security account number, military identification card, and credit cards. Only if you cannot identify yourself with such information may the Agency require additional information concerning your employment and personal or family history in order to verify his identity.

• The Agency will provide trained personnel to explain any information furnished to you pursuant to Civil Code 1786.10. The Agency will provide a written explanation of any coded information contained in your file. This written explanation shall be distributed whenever a file is provided to you for visual inspection.

• You may be accompanied by one other person of your choice when you come to inspect your file. This person must furnish reasonable identification. The Agency may require you to furnish a written statement granting permission to the Agency to discuss your file in your companion’s presence. Resumen de sus derechos bajo el Código Civil de California 1786.22 Una agencia de informes de investigación de consumidores (“Agencia”) proporcionará archivos e información que usted tiene derecho a inspeccionar durante el horario comercial normal y con un aviso razonable. Todos los archivos que Sterling mantenga acerca de usted serán puestos a su disposición para inspección visual, como sigue:

• En persona, si usted comparece en persona y proporciona la identificación apropiada. Se pondrá asimismo a disposición suya una copia del informe por un costo no superior al costo efectivo de hacer las copias.

• Por correo certificado, si usted efectúa una solicitud escrita, con identificación apropiada, para que se envíen copias a una dirección especificada. No obstante, las agencias que cumplan con una solicitud de tal tipo de envío por correo no serán responsables de las divulgaciones a terceros causadas por un manejo inapropiado del correo una vez que salga de la Agencia.

• Se proporcionará por teléfono un resumen de toda la información contenida en su archivo y que se requiera que sea proporcionada en virtud del Código Civil de California, si usted efectúa una solicitud escrita, con identificación apropiada.

• El término “Identificación apropiada” incluye documentos tales como una licencia válida para manejar, número de cuenta del Seguro Social, tarjeta de identificación militar, y tarjetas de crédito. Únicamente si usted no puede identificarse con tal información la Agencia podrá requerir información adicional en relación con su empleo e historial personal o familiar para verificar su identidad.

• La Agencia proporcionará personal capacitado para explicar cualquier información proporcionada a usted de conformidad con el Código Civil 1786.10. La Agencia proporcionará una explicación escrita de cualquier información codificada contenida en su archivo. Esta explicación escrita será distribuida siempre que un archivo le sea proporcionado a usted para inspección visual.

• Usted puede estar acompañado por otra persona de su elección cuando venga a inspeccionar su archivo. Esta persona debe proporcionar una identificación razonable. La Agencia puede requerir que usted proporcione una declaración escrita concediendo permiso a la Agencia para hablar de su archivo en presencia de la persona que le acompañe

BACKGROUND SCREENING AUTHORIZATION
I have carefully read and understand this disclosure and authorization form and I have received a copy of the “Summary of Your Rights Under the Fair Credit Reporting Act” provided with this form. I have had the opportunity to review my rights. By my signature below, I consent to the preparation of background reports by Intelius Screening Solutions LLC, and to the release of such reports to the Company and its designated representatives for the purpose of assisting the Company in making a determination as to my eligibility for employment, promotion, retention, contract assignment or for other lawful purposes.

I understand that, to the extent allowed by law, information contained in my job application or otherwise disclosed to the Company by me before or during my employment or contract assignment, if any, may be utilized for the purpose of obtaining such consumer reports and/or investigative consumer reports about me. I understand that nothing herein shall be construed as an offer of employment or contract for services.

I hereby authorize law enforcement agencies, learning institutions (including public and private schools and universities), information service bureaus, credit bureaus, record/data repositories, courts (federal/state/local), motor vehicle record agencies, my past or present employers, the military, and other individuals or sources to furnish any and all information on me that is requested by the consumer reporting agency.

By my signature (including electronic) below, I certify the information provided on and in connection with this form is true, accurate, and complete. I agree that this form in original, faxed, photocopied or electronic form will be valid for any background reports that may be requested by or on behalf of the Company
Signature*

Clear
Date*

MonthDayYear
Date
I hereby agree to all terms of this application and authorize my signature represented by checking this box

Submit Application
Should be Empty:

The Ambassador Volunteer Program

EMERGENCY INFORMATION

EXPOSURE/ENVIRONMENTAL CONDITIONS

BACKGROUND DISCLOSURE AND AUTHORIZATION FORM

BACKGROUND SCREENING AUTHORIZATION

Submit Application