VOLUNTEER REGISTRATION

NRHEG

306 Ash Ave S, New Richland, MN 56072
VOLUNTEER REGISTRATION

Personal Information
Todays Date

MonthDayYear
Date
Name

First NameMiddle NameLast Name
Other Name
Address
City
State
Zip Code
Date of Birth *

MonthDayYear
Date
Phone Number
Please enter a valid phone number.
Email
example@example.com
Current School Year
Building to Volunteer at (select all that apply)

ElementarySecondaryCommunity Ed
Describe volunteer service

Background Information
Background Checks are required for all volunteers. Classroom and Community Ed volunteer background checks are paid by the District. All other volunteer types (field trip chaperones, etc) are paid by the volunteer. Please note that there may be an additional fee if the initial background check requires further searches) The volunteer may not begin until the background check has been received and registration has been approved. Criminal charges or convictions are not an automatic bar to volunteer service. The District will consider the nature of offense, date of the offense, and relationship between the offense and volunteer position.
Have you ever been convicted of a: felony, misdemeanor, or forfeiture (fine for municipal ordinance violation)? If yes, attach an explanation, giving dates and location (City, State):

YesNo
Conviction Information
Is there a felony, misdemeanor, or forfeiture charge currently pending against you? Yes If yes, attach an explanation, giving dates and location (city, state):

YesNo
Pending Charges
| hereby certify that the above information to the best of my knowledge is true, accurate, and complete. Any misrepresentations or willful omissions of facts shall be sufficient cause for disqualification from volunteer service. Furthermore, it is understood that this registration and records become the property of the District, which reserves the right to accept or reject it. I further agree to abide by all rules, regulations, and policies of the District. I hereby authorize the NRHEG Public Schools to utilize third party agencies to collect reports by contacting law enforcement agencies, city, state, county, and federal courts to release information about my background including, but not limited to, information about my criminal record. This releases the aforesaid parties from any liability and responsibility for collecting the above information. This release shall remain in effect for the length of my volunteer service. I understand I have the right to obtain a copy of background check reports if the written request is made within 60 days of signature below.

I understand I will be responsible for maintain confidentiality regarding information seen and/or heard while working as a volunteer.
Signature of Applicant

Clear
Equal Opportunity Assurance: NRHEG Public Schools complies with provision of Title IX of the Education Amendments of 1972, Section 504 of the Rehabilitation Act 1973, and Title VI of the Civil Rights Act of 1964, and does not discriminate of the basis of race, color, religion, national origin or ancestry, age, sex, marital status or handicap in its employment practices. Questions regarding compliance should be addressed to: Local Compliance Office, Superintendent of Schools. Office Use Only Background Check Approved (Superintendent):
Should be Empty:

NRHEG

VOLUNTEER REGISTRATION