Fillable Last Name First Middle Birthdate Age (Florida Department of Corrections)

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Last Name First Middle Birthdate Age (Florida Department of Corrections)

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The Last Name First Middle Birthdate Age (Florida Department of Corrections) form is 5 pages long and contains:

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BROWSE FLORIDA DEPARTMENT OF CORRECTIONS FORMS

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Last Name First Middle Birthdate Age
Home Phone Cell Email
Mailing Address City State Zip
Category ☐Retired ☐College Student ☐Middle/High Student ☐Military ☐Parent ☐Other
Health (any physical limitations)
Name of School(s) or Department / Type of Volunteer work Interested in Performing
Have you had any change of name in the past or used an assumed name? ☐ No ☐ Yes
If yes, please list other names and time frames
Volunteer Signature
In case of emergency, please notify
Date
Relationship
Home Phone Cell
Address City State Zip
Parent Permission – If the volunteer applicant is under the age of 18, a parent or legal guardian must sign.
I, (parent or legal guardian), grant permission for
to volunteer for Santa Rosa County District Schools.
Parent/Legal Guardian Signature Date
If you are approved to volunteer, then it is not necessary to complete a Field Trip form.
This form must be submitted annually.
School or
Department Name
Student(s)
Days / Hours
Available
Santa Rosa County District Schools
Volunteer Application
SR000003 RVSD 01/2020
Are you an FRS retiree? ☐ No ☐ Yes If Yes, Date of Retirement
I understand that if I retired from an FRS position in the last year, I may not volunteer with the school
district as that would potentially void my retirement and possibly require me to repay benefits received.
Volunteer Signature Date
Volunteer Acknowledgment
I understand that I am offering my services to the Santa Rosa County School System without
compensation and without any rights to health benefits in case of illness or injury.
School
School
School
Volunteer Application - Security Background Check
THIS FORM MUST BE SUBMITTED WITH YOUR APPLICATION
Name Driver’s License Number
The following questions must be answered truthfully. A “YES” answer will not necessarily disqualify you
from consideration. However, the Santa Rosa County District School Board reserves the right to request
that you complete the fingerprinting process.
YES NO
☐ ☐ 1. Have you ever been convicted of an offense other than a minor traffic violation? (DUI and
DWI convictions are not minor and must be reported.)
☐ ☐ 2. Have you ever been found guilty of a criminal offense?
☐ ☐ 3. Have you ever entered a nolo contendere or no contest plea?
☐ ☐ 4. Have you ever had a criminal record sealed?
☐ ☐ 5. Have you ever had a criminal record expunged?
☐ ☐ 6. Have you ever had adjudication withheld in a criminal offense?
☐ ☐ 7. Have you ever entered a pre-trial intervention program for a misdemeanor or felony
charge?
☐ ☐ 8. Are there criminal charges currently pending against you?
☐ ☐ 9. Have you ever been placed on court-ordered probation, imprisoned or jailed in a criminal
proceeding?
☐ ☐ 10. Have you ever failed to appear in court or forfeited bond in a criminal proceeding?
☐ ☐ 11. Have you ever been confirmed as a child abuser by HRS or a similar agency in Florida or
another state?
☐ ☐ 12. Have you ever been suspended without pay, or dismissed from employment or resigned
while an Investigation was in progress for possible disciplinary action?
If you answered “YES” to question 1, 11, or 12, you must give a detailed explanation below:
Santa Rosa County District Schools
SR000003 RVSD 01/2020
Volunteer Application - Security Background Check
THIS FORM MUST BE SUBMITTED WITH YOUR APPLICATION
Date Arresting Agency Where Arrested Offense Final Disposition
By signing this document, I certify that all information contained herein is true and accurate. My signature
further certifies that there is no falsification of any information, omission of any information requested, or any
misrepresentation of information requested. I also understand that my fingerprints may be submitted to the
Florida Department of Law Enforcement and the Federal Bureau of Investigation for a complete criminal
history background check at the request of the Santa Rosa County District School Board. By my signature, I
certify that I know, understand, and agree that any false statement or omission of information requested will
result in my name being removed from the approved volunteer list of the Santa Rosa County District School
Board.
Signature of Volunteer Applicant Date
Santa Rosa County District Schools
SR000003 RVSD 01/2020
Printed Name of Volunteer Applicant
Signature of Volunteer Applicant Date
Santa Rosa County District Schools
Volunteer Applicant Statement
THIS FORM MUST BE SUBMITTED WITH YOUR APPLICATION
I understand that all information provided to Santa Rosa County will become a matter of public record and
will be open to inspection as required by Florida Statute.
I understand that if I am a former FRS employee, I may not volunteer with the school district for at least one
year following my retirement date as that would potentially void my retirement and possibly require me to
repay any benefits received. I will check with FRS at the end of my first year following my retirement to
determine the date I may begin serving as a volunteer.
I certify that the foregoing answers are true and correct to the best of my knowledge. I authorize the
investigation of all statements contained in this application and hereby give Santa Rosa County permission
to contact schools, previous employers, references, and other and hereby release the organization from
any liability as a result of such contact. I understand that any false or misleading information or omission of
facts requested in this application may remove me from further consideration as a volunteer for Santa Rosa
District Schools.
I understand that my volunteer service with Santa Rosa District Schools is for no specific length of time but
is based on the needs of the school district and my willingness to devote my time and skills to support it.
The contents of the volunteer policies as well as other Santa Rosa District Schools policies and procedures
are subject to change. It is my responsibility to read, understand and follow such policies.
Santa Rosa District Schools requires all volunteer applicants to undergo a criminal background screening
and Florida driver license verification prior to working in our school district, and my signature authorizes
such screenings. I also authorize Santa Rosa District Schools to review and make decisions based on any
content found on any and all internet and social media sites.
SR000003 RVSD 01/2020
Volunteer Applicant Expectation
THIS FORM MUST BE SUBMITTED WITH YOUR APPLICATION
As a Santa Rosa County District Schools Volunteer:
1. I shall hold absolutely confidential all information that I may obtain directly or indirectly while serving
as a Santa Rosa County volunteer.
2. I shall read and comply with the policies set forth in the Administrative Code.
3. I will donate my services to Santa Rosa County without contemplation of compensation or future
employment and give my service for humanitarian and charitable purposes.
4. I shall not sell or attempt to sell goods or services, request contributions or solicit person to sign or
distribute political petitions on Santa Rosa Schools premises.
5. I will be punctual and conscientious, conduct myself with dignity, courtesy and consideration of others
and will endeavor to maintain a professional appearance and deliver quality services.
6. I will attempt to resolve any problems related to my volunteer activities with my supervisor and, if
unsuccessful, attempt to resolve any such problems with school or district administration.
7. I will uphold the professional conduct and standard of Santa Rosa County at all times while
interacting with students, parents, and school district personnel.
8. I understand Santa Rosa District Schools may release me as a volunteer at any time.
9. I understand that Santa Rosa District Schools assumes no responsibility for any contact, visits or
services provided by me that are beyond the scope of responsibilities defined by my specific
volunteer assignment.
I have read and understand the Volunteer Expectations as stated above and agree to adhere to them while
serving as a volunteer for Santa Rosa District Schools.
Printed Name of Volunteer Applicant
Signature of Volunteer Applicant Date
If the volunteer applicant is under the age of 18, a parent or legal guardian must sign. P
rinted
Name of Parent/Legal Guardian
Parent/Legal Guardian Signature Date
SR000003 RVSD 01/2020
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Last Name First Middle Birthdate Age (Florida Department of Corrections)

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Completed 13 September 2021

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