September 5, 2001 - Schoolwires



VOLUNTEER PROFILEThank you for your interest in being a volunteer. Please print clearly. Complete this form, Volunteer Disclosure Statement, and Volunteer Agreement. By completing these forms, and after a successful background check (RCW 10.97 Request for Criminal History Record) processed through Washington State Patrol and a national criminal history database, you will be contacted by the school. Processing may take up to ten (10) days. Fingerprints of volunteers may be required. Volunteers may request a copy of their background check results. The North Beach School District requires school volunteers to renew their background checks every year. INFORMATION ON THIS FORM IS USED FOR VOLUNTEER PURPOSES ONLY.Please fill out the information below.Please provide a photocopy of a valid, current Washington State Driver’s License/ID.Please fill out the Volunteer Disclosure StatementPlease sign the Volunteer AgreementIs this a renewal application? Yes ? No ?Have you lived in WA for the past 5 consecutive years? Yes? No?Name: LastFirstMiddleAlias/Maiden Name: Address: Street/PO BoxCityStateZip CodeHome Phone: Cell Phone: E-Mail Address: Date of Birth: Sex: Race: MM/DD/YYYYI, the undersigned, authorize the NBSD to conduct a name/birthdate criminal history check with the Washington State Patrol and a national criminal history database to determine the existence of any arrest resulting in conviction.Signature of ApplicantDateFOR OFFICE USE ONLYI have seen this volunteer’s photo identification and the name and date of birth listed above are correct.Staff SignatureDateAs of this date, the volunteer named above shows ?NO EVIDENCE ?EVIDENCE pursuant to RCW 43.43.830 through 43.43.845 and ?IS ?IS NOT qualified to volunteer in our district.Staff SignatureDate ................
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