PUTNAM COUNTY SCHOOL DISTRICT
| |
|Early Learning Coalition of North Florida, Inc. |
|Volunteer Application |
|2450 Old Moultrie Rd., Suite 103 |
|St. Augustine, FL 32086 |
|Telephone: 904-342-2267 Fax: 904-342-2268 |
|Web Site: |
|Contact: Joan Whitson, Early Literacy Coordinator: jwhitson@ |
|Please return this form by e-mail, mail, fax, or in person. |
|Please print and use legal names. Every box must be completed to be processed. |
| LAST NAME |FIRST NAME |MIDDLE NAME |OTHER NAMES USED OR MAIDEN NAME |
| | | | |
|MAILING ADDRESS |CITY |COUNTY |STATE |ZIP |SOCIAL SECURITY NUMBER |
| | | | | | |
|BIRTH DATE (MM/DD/YY) |TELEPHONE NUMBER |CELL PHONE NUMBER |
| | | |
|GENDER |Which of these terms best describe you? |
| | |
|( Male ( Female |( White ( Asian ( Hispanic ( African American ( American Indian ( Multi- racial |
| |
|Do you currently work for the Baker, Bradford, Clay, Nassau, Putnam or St. Johns County School District? Yes No ______ |
| |
|Have you read, signed, and attached the Affidavit of Good Moral Character form to this Volunteer Application? (Failure to do so will result in your request|
|to volunteer being denied.) |
|Yes _____ No ______ |
| |
| |
|Your Email Address: __________________________________________________________________________ |
| |
| |
|By signing this form, I understand that I waive ANY liability claims with the Early Learning Coalition of North Florida, Inc. , for any incident incurred |
|during (and in the capacity of) my volunteer work for the Coalition. |
| |
|Your signature: ________________________________ Date: _________________________________ |
| |
|A background check will be conducted on ALL volunteers assisting with the Early Learning Coalition of North Florida, Inc. |
| |
|I hereby authorize the Early Learning Coalition of North Florida to check any and all records pertaining to criminal convictions, and for any law |
|enforcement agency to release information regarding convictions under Florida statutes or statues of other jurisdiction. |
| |
| |
|Your signature: ________________________________ Date: _________________________________ |
FOR OFFICE USE ONLY
_______ Volunteer Application Completed?
_______ DCF Affidavit of Good Moral Character Completed?
_______ Local Law Enforcement Criminal Records Check completed and returned, clear?
_______ Florida Sexual Offenders and Predators Check, clear?
_______ Florida Sexual Offenders and Predators Email/IM Check, clear?
_______ Dru Sjodin National Sex Offender Public Website, clear?
_______ Coalition Volunteer Agreement – Volunteer Policy Handbook
| |
|Approval Date: ______________________________ |
|Notification of Approval Date: __________________ |
................
................
In order to avoid copyright disputes, this page is only a partial summary.
To fulfill the demand for quickly locating and searching documents.
It is intelligent file search solution for home and business.
Related download
- application 2006 2007 no child left behind blue ribbon
- section d florida living shorelines
- southern district of florida united states bankruptcy court
- ads instructions document
- acknowledgment of responsibility and registration form
- putnam county school district
- florida department of education
- school year st st johns county school district
- laurie k weatherford
- middle district of florida united states district court
Related searches
- st louis county school district map
- washoe county school district infinite ca
- gadsden county school district fl
- shelby county school district memphis
- baltimore county school district locator
- washoe county school district net
- leon county school district jobs
- clark county school district jobs
- clark county school district calendar
- washoe county school district registration
- washoe county school district parent portal
- clark county school district records request