Volunteer Application

Volunteer Application
Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email*
example@example.com
Phone Number*

Area CodePhone Number
Emergency Contact*

First NameLast Name
Phone Number*

Area CodePhone Number
Do you have any medical concerns that you feel we should be aware of?*

YesNo
If yes, please explain below:*

As a volunteer working in the School District Augusta, I fully understand that this position is, as stated, on a volunteer basis which inherent in its meaning, entitles me to no pay or wage for my services. I further understand that I am expected to follow the rules of behavior that are expected of other staff which are hired by the district. I will be accountable to the building administrator, athletic director and the Augusta School Board. I do understand that this agreement can be terminated without notice at any time by either the school district or the volunteer.

To ensure the safety of both the volunteer and student, I authorize the district to make a confidential background check, and I will provide the necessary information to do so (on the other side of this document)

I have read and understand this agreement. The undersigned certifies that the information provided is accurate.
Signature

Clear
Date

MonthDayYear
Date

Criminal Background Check Information

If you are volunteering in our schools,a criminal background check will be required.
Have you ever been convicted of a crime?*

YesNo
In order to complete a criminal background check in the State of Wisconsin we need to know your date of birth and social security number.*
Social Security Number
Date of Birth*

MonthDayYear
Date
I certify that the answers given by me in this form are true and correct without omission of any kind. I agree that the district shall not be held liable in any respect if my approval is terminated because of false statements, answers or omissions made by me in the form. I authorize the school district to make any investigation of my personal or employment history and authorize any former employer, person, firm, corporation or governmental agency to disclose to the school district any information they may have regarding me. In consideration of the school district’s review of this application, I hereby release the district as well as all providers of information from any liability and for any damage that may result from the furnishing and receiving of this information. A copy of this authorization and release is as valid as the original and should be recognized as such.
Signature*

Clear
Date signed*

MonthDayYear
Date
The Augusta School District is an equal opportunity employer and is committed to a policy of nondiscrimination in relation to race, religion, sex or sexual orientation, age, national origin, handicap, marital status, political affiliation, arrest or conviction record, or other factors provided for by state and federal laws.
Should be Empty:

Volunteer Application

Criminal Background Check Information