Volunteer Application

Volunteer Application
Date

MonthDayYear
2 digit month, 2 digit day, 4 digit year
Name

First NameMiddle NameLast Name
Phone Number
Format: (000) 000-0000.
Email
example@example.com
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
We need the following information to complete a criminal background check
Birthdate

MonthDayYear
Are you 18 are older?
Are you 14 or older?
If not, please list the parent or guardian you will be volunteering with:
Please check one
Race
Emergency Contact
Please check all areas you are willing to volunteer for:

Other
Please list specific Programs/Activities/Seasons
Please list any applicable certifications
Please list any past applicable experience
Volunteer Informed Consent and Release

I offer to volunteer my services to the Geneseo Park District, and recognize that I will not be paid for my time. As a volunteer, I acknowledge that there are certain risks of physical injury to volunteers in their activities, and I agree to assume full risk of any and all injuries, damages or loss, that I may sustain as a result of said participation. I further agree to waive and relinquish all claims I may have (or accrue to me) as a result of volunteering in this activity against the Geneseo Park District, including its officers, officials, agents, volunteers and employees. Additionally, I hereby give consent for the Park District to use photos or video coverage of me in future publications and promotions, and that these photos/videos remain the property of the Park District.
Criminal Background Check Authorization

I understand the Park District is required by state statute [70 ILCS 1205/8-23] to obtain criminal conviction information concerning applicants and shall perform a criminal background check for applicants for all positions, including the position for which you have applied. Pursuant to said statute, certain convictions shall automatically disqualify the applicant from consideration for working for the Park District. All other convictions shall not automatically disqualify the applicant from consideration, but rather, the conviction will be considered in relationship to the specific job. Applicants are not obligated to disclose sealed or expunged records of conviction. Further, the Park District complies with all aspects of the Illinois Human Rights Act and other applicable laws regarding, for instance, requirements for pre-adverse action notices, adverse action notices and interactive discussions to determine the relevance of convictions to the job position.

I herby authorize the Geneseo Park District to conduct an investigation of possible criminal offenses in my background, as required by section 8-23 of the Park District Code. (70ILCS1205/8-23)
Have you ever been convicted of any felony?
Have you ever been convicted of a misdemeanorinvolving dishonesty, criminal sexual conduct, assault or battery, or anycriminal drug statute?
By providing my name below, I herby verify that I have not been convicted of or found to be a child sex offender.
Date

MonthDayYear
2 digit month, 2 digit day, 4 digit year
By providing my name below, I herby authorize the Geneseo Park District to conduct an Illinois State Police Criminal Background Investigation.
Date

MonthDayYear
2 digit month, 2 digit day, 4 digit year
Should be Empty: