Volunteer Application (Page 3 of 5) in pdf

Volunteer Application Page 3

North Clackamas School District

Volunteer Criminal History Verification/Background Check Authorization Form

TO BE COMPLETED BY CANDIDATE

PLEASE PRINT ALL REQUESTED INFORMATION.

Full Legal Name:_____________________________________________________________________________________________

Last

First

Middle

Other Names Used:___________________________________________________________________________________________

Current Address:___________________________________________________________Phone:____________________________

City/State/ZIP Code: ___________________________________________________E-Mail:________________________________

Driver License # / State:____________________ Social Security #:_____________________________ Date of Birth:_____________

(Optional)

I waive and will not bring any claim against NCSD, including negligent acts of district agents, for damage to my personal property or any

injury to myself as a result of my volunteer activity. I agree to this action to the fullest extent allowed by law. Applicants that fail to

complete information provide misrepresentations or untrue facts will be denied the opportunity to volunteer. Per NCSD policy/standard

practice, in an effort to maintain a safe environment, criminal history verification is required for some volunteer activities.

List all your previous addresses in the last 10 years including all school and military locations.

Date From

Date to

Complete Street Address

City/State

Zip

Current

Please complete both sides of this form before submitting

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Volunteer Application Page 3