Cdss Employment/volunteer Verification Form - Blaze Sports America printable pdf download

Cdss Employment/volunteer Verification Form - Blaze Sports America

CDSS Employment/Volunteer Verification Form

Name: Last ___________________________ First ___________________________ M.I. _____

Agency: ______________________________ Job title: ________________________________

Address: ______________________________________________________________________

City: ________________________________ State _____________________ Zip ___________

Email: ________________________________________________________________________

Phone: ________________________________ 2nd Phone: _____________________________

Adaptive Sport/Physical Activity Direct Service Summary

Dates of Service

Program Name

Position

Duration of

Verification**

service*

___yes ___no

Total experience: ____________

*Duration of Service: Number of hours of service is not required. Estimates of service by month, year or season are

satisfactory.

_________________________________

_____________________

Signature of Applicant

Date

Verification of Service: As supervisor or manager to the CDSS candidate above, I hereby attest to the

accuracy of the service experience detailed on this form.

_______________________________________

__________________________

Signature of Supervisor

Phone

_______________________________________

__________________________

Supervisor Name, Title, Organization

Date

BlazeSports America, Certified Disability Sport Specialist Program

1670 Oakbrook Dr. Suite 331, Norcross, GA 30093

Phone: 404-270-2000 FAX: 404-270-2039 Email:

Cdss Employment/volunteer Verification Form - Blaze Sports America