Taylor County School District

Taylor County School District

Volunteer Application
Name*

First NameLast Name
MI
Address*

Mailing Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Zip*
Cell Phone*
Format: (000) 000-0000.
Home Phone
Format: (000) 000-0000.
Work Phone
Format: (000) 000-0000.
Date of Birth*

MonthDayYear
Date
Do you have any health or physical limitations or restrictions? If yes, please explain.

YesNo
If yes, please explain.
What languages other than English do you speak fluently?
Please provide two (2) references.
Reference #1 Name*
First and Last Name
Reference #1 Address*

Street Address, City, State and Zip

Street Address Line 2

CityState / Province

Postal / Zip Code
Reference #1 Cell Phone*
Format: (000) 000-0000.
Reference #1 Position*
Reference #2 Name*
First and Last Name
Reference #2 Address*

Street Address, City, State and Zip

Street Address Line 2

CityState / Province

Postal / Zip Code
Reference #2 Cell Phone*
Format: (000) 000-0000.
Reference #2 Position*
Types of volunteer work preferred
Preferred schools
Preferred Grade Level
Are you a parent or legal guardian at this school?*

YesNo
If Yes, please list the name of the student(s).
Please enter first and last name of each student.
If Yes, please list your student's grade(s).
Please list the grade of each student.
What days and times will you be able to assist our students?
FOR THE SAFETY AND PROTECTION OF OUR STUDENTS. A BACKGROUND CHECK MAY BE DONE ON PERSONS WHO PARTICIPATE IN STUDENT CONTACT ACTIVITIES.

Being convicted of a crime or having adjudication withheld will not necessarily prohibit you from being approved as a volunteer. All factors regarding the incident will be takin into consideration in determining your suitability or specific assignment. If approved, the misrepresentation of any of this information will result in your termination as a volunteer in Taylor County Schools. A copy of your driver's license will be made and filed with this application. I understand that such information may be utilized in determining my suitability as a volunteer.
Have you ever been convicted, found guilty, entered a plea of nolo contendre (no contest), or had adjudication withheld in a criminal offense other than a minor traffic violation; or are there any criminal charges now pending against you other than a minor traffic violation? (DUI is no considered a minor traffic violation and must be listed.) A YES OR NO ANSWER IS REQUIRED BY FLORIDA LAW. You must acknowledge the existence of any criminal or delinquency record regardless of whether the decision was withheld or dismissed by the court and regardless of whether or not those records have been sealed or expunged. If you respond YES, you must give complete information for each charge below.

YESNO
City Where Arrested - 1
State - 1
Date Arrested - 1

MonthDayYear
Date
Charges - 1
Disposition - 1
City Where Arrested - 2
State - 2
Date Arrested - 2

MonthDayYear
Date
Charges - 2
Disposition - 2
File Upload

Please upload any additional pages necessary to explain all criminal charges.
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I understand that I am offering my services to the Taylor County Schools without compensation. I certify all information given on this application is true and complete. I understand any misrepresentation, omission, or incorrect statement of fact given by me in this application is cause for my immediate dismissal as a volunteer. I agree, If I am a volunteer, to abide by all School Board rules, regulations, and policies, either published or in effect by usage, and all rules, regulations and laws of the State of Florida, the Florida State Board of Education, and the Taylor County School Board.
SIGNATURE*
DATE*

MonthDayYear
Date
Driver's License File Upload*

Please upload a copy of the front and back of your Driver's License here
Cancelof
THE INFORMATION IN THIS APPLICATION BECOMES PUBLIC RECORD UPON RECEIPT.

Applicants are considered for all positions without regard to race, color, religion, sex, national origin, age, marital status, or disability.
TCSB #99003 (7/6/99)
Should be Empty:

Taylor County School District

TCSB #99003 (7/6/99)