Fillable Little League Baseball And Softball Tournament Umpire Request Form (Page 2 of 2) in pdf

Little League

Volunteer Application - 2016

Do not use forms from past years. Use extra paper to complete if additional space is required.

A COPY OF VALID GOVERNMENT ISSUED PHOTO IDENTIFICATION MUST BE

Please list three references, at least one of which has knowledge of your participation as a

ATTACHED TO COMPLETE THIS APPLICATION.

volunteer in a youth program:

Name __________________________________ Date ___________________

Name/Phone

Address ________________________________________________________

______________________________________________________________________

City ____________________________ State _________Zip _____________

______________________________________________________________________

Social Security #

_______________

(mandatory with First Advantage or upon request)

______________________________________________________________________

Cell Phone

Business Phone

IF YOU LIVE IN A STATE THAT REQUIRES A SEPARATE BACKGROUND CHECK BY LAW, PLEASE ATTACH A COPY

Home Phone: _____________

E-mail Address:

OF THAT STATE’S BACKGROUND CHECK. FOR MORE INFORMATION ON STATE LAWS, VISIT OUR WEBSITE:

Date of Birth ____________________________________________________

Occupation _____________________________________________________

AS A CONDITION OF VOLUNTEERING, I give permission for the Little League organization to conduct background

Employer _______________________________________________________

check(s) on me now and as long as I continue to be active with the organization, which may include a review of sex

Address ________________________________________________________

offender registries (some of which contain name only searches which may result in a report being generated that

Special professional training, skills, hobbies: ___________________________

may or may not be me), child abuse and criminal history records. I understand that, if appointed, my position is

_______________________________________________________________

conditional upon the league receiving no inappropriate information on my background. I hereby release and agree

to hold harmless from liability the local Little League, Little League Baseball, Incorporated, the officers, employees

Community affiliations (Clubs, Service Organizations, etc.):

and volunteers thereof, or any other person or organization that may provide such information. I also understand

_______________________________________________________________

that, regardless of previous appointments, Little League is not obligated to appoint me to a volunteer position. If

Previous volunteer experience (including baseball/softball and year):

appointed, I understand that, prior to the expiration of my term, I am subject to suspension by the President and

removal by the Board of Directors for violation of Little League policies or principles.

_______________________________________________________________

Applicant Signature _______________________________________ Date _________

Do you have children in the program? Yes

If yes, list full name and

what level? _____________________________________________________

If Minor/Parent Signature___________________________________Date __________

Special Certification (CPR, Medical, etc.): ______________________________

Applicant Name(please print or type) _______________________________________

Do you have a valid driver’s license: Yes

NOTE: The local Little League and Little League Baseball, Incorporated will not discriminate against any

person on the basis of race, creed, color, national origin, marital status, gender, sexual orientation or

Driver’s License#: ________________________________State ___________

disability.

Have you ever been convicted of or plead guilty to any crime(s) involving or against

a minor?:

Yes

LOCAL LEAGUE USE ONLY:

If yes, describe each in full: _________________________________________

Background check completed by league officer ________________________________

_______________________________________________________________

on ____________________________________________________________________

Are there any criminal charges pending against you regarding any crime(s) involving

or against a minor?

Yes

No If yes, describe each in full:______________

System)s) used for background check (minimum of one must be checked):

__________________________________________________________________

Have you ever been refused participation in any other youth programs? Yes

Sex Offender Registry

Criminal History Records

*First Advantage

If yes, explain: ___________________________________________________

*Please be advised that if you use First Advantage and there is a name match in the few states

_______________________________________________________________

where only name match searches can be performed you should notify volunteers that they will

In which of the following would you like to participate? (Check one or more.)

receive a letter directly from LexisNexis in compliance with the Fair Credit Reporting Act containing

information regarding all the criminal records associated with the name, which may not necessarily

League Official

Coach

Umpire

Field Maintenance

be the league volunteer.

Manager

Scorekeeper

Concession Stand

Other

Only attach to this application copies of background check

reports that reveal convictions of this application.

Little League Baseball And Softball Tournament Umpire Request Form Page 2

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