GEM COUNTY RECREATION DISTRICT
VOLUNTEER APPLICATION
The following information is required by the Gem County Recreation District from all potential applicants to ensure that volunteers have a safe and enjoyable volunteer experience and that the children and adults enrolled in our programs are safe and secure. Each question must be truthfully answered. If you have any questions regarding this application contact Abra Dodson, Recreation Director 365-5748, at 107 East Main, Emmett, Idaho83617.
Full Name ______Date of Birth ______Address______City ______Zip ______
Day Phone ______Evening Phone ______Employer ______Occupation ______
Work Address ______City ______Zip ______
E-mail Address ______
Age of youth I am interested in coaching/ refereeing: (circle One)
SPORT(S) I aminterested in (Circle one) coaching/ refereeing: ______
Have you coached before: (circle one) YES or NO. If answer is YES, please provide when, where and why you left. ______
______.
Shirt Size: ______
I am available to coach/ referee: (Circle all that apply) M T W TH F Sat Sun
I am available to volunteer my services: (Circle all that apply) Weekdaysor Evenings or Weekends.
I am available to volunteer at this time of day: ______
Why do you want to volunteer for the Gem County Recreation District? ______.
Are you interested in being contacted to volunteer for special events? YES or NO
Volunteers with the Gem County Recreation District may be asked to teach classes, tutor, assist with loading and unloading materials, clean-up work areas, and in doing so may have to climb ladders, drive, sweep, read, write, run, lift, etc. Is there any reason why you will be unable to perform any of these duties? ______.
Previous volunteer experience: ______
______
Name of person to contact in case of emergency: ______. Telephone number of Contact Person ______
Relationship to Contact Person: ______.
Health Care Information if applicable (provider, number, facility): ______
I currently have a Valid Idaho Driver’s License? (circle one) YES or No
Has your driver’s license ever been revoked, suspended or restricted? YES or No
If YES, please explain: ______.
CRIMINAL HISTORY
Have you ever been convicted by any court, including military court, of any offense? (circle one) YES or NO If YES, please explain each offense, the violation, court, place of conviction, penalty, including sentence received and date of court probation. Also include name under which you were convicted if other than that listed above. (You may omit any traffic offense for which the fine was less that $200, and any record which has been sealed.)______
______.
Have you been arrested for any offense for which a trial is currently pending? (circle one) YES or NO If YES, please explain nature of each charge and date of citation orarrest:
______.
Have you been convicted of any offense involving child molestation? (circle one) YES or NO If YES, please explain ______
______.
Have you ever been convicted of any crime of violence, including misdemeanor or felony?
YES or NO. If YES, please explain: ______
I swear (affirm) under penalty of perjury, that the information above is true and correct.
Name ______
Signature ______
Date ______
AUTHORIZATION AND AGREEMENT
THE DISTRICT’S CRIMINAL HISTORY CHECK WILL FOCUS ON CONVICTIONS WHICH WOULD DISQUALIFY ME FROM EMPLOYMENT OR THE OPPORTUNITY TO VOLUNTEER. ANY FALSIFIED INFORMATION MAY RESULT IN IMMEDIATE DISQUALIFICATION OF APPLICANT OR TERMINATION OF VOLUNTEER.
Request, Authorization and Consent for Release of Information to Employer and Release from Liability for Disclosure or Information
I understand that in connection with the application process, Gem County Recreation District may request information from my past employers, educational institutions, personal references, and any public or private agencies that have issued me either a professional or vocational certification or license. I also understand that such investigation may include a review of any criminal history records. Prior to signing this form, I read the Gem County Recreation District’s Application Background Investigation Policy, which I fully understand. I have provided complete and truthful information to the Gem County Recreation District regarding all sources of information about my past employment, volunteer services, driving licensure, criminal conviction record, as well as any other information requested in the volunteer application, and have been fully informed that any misrepresentations or material omissions concerning such information will be grounds for denying my application, withdrawing any offer of volunteer participation, or immediate discharge. In order to assist Gem County Recreation District in obtaining documents and information to confirm my background, if necessary, I hereby consent to the release of information more specifically described below.
I request, authorize, and consent to the Gem County Recreation District’s thorough investigation of whether I have a criminal history, and if so, the nature of such criminal record and all surrounding circumstances available through lawful means. Gem County Recreation District has advised me that its criminal background check will focus on convictions which would disqualify me from employment/volunteerism.
I further hereby release and hold harmless Gem County Recreation District, its officers, employees and agents, and any other person, or public or private industry entity inquiring about, investigating, furnishing, communicating, reviewing or evaluating information or documents pursuant to the Request, Authorization, Consent, and Release, or making any written or verbal communications for such purposes, from any and all claims arising from such activities, including but not limited to, any claims whatsoever for defamation, fraud, misrepresentation, negligent interference with prospective business relations or contract, breach of contract (including any settlement agreement), negligent infliction of emotional distress, employment discrimination, violation of public policy, and any other potential claims, unknown to me presently, that I may have, now or in the future. I voluntarily grant this release for purposes of supporting my application for employment and based upon my desire to encourage the Gem County Recreation District’s consideration of my application.
I have carefully read this Request, Authorization, Consent, and release and have voluntarily agreed to its terms to assist Gem County Recreation Districtin evaluating my qualifications for employment/volunteer services and in meeting the business necessity of hiring honest, trustworthy, reliable employees/volunteers who are nonviolent and do not pose a risk of serious harm in the workplace. I additionally agree to fully cooperate with Gem County Recreation District in permitting the release of the above information and reports. I additionally understand that all information and documents generated, received, or maintained by Gem County Recreation District during, or as a result of, its investigation, will be maintained as confidential information and that Gem County Recreation District will not release such information or documents to me.
Name ______
Signature ______
Date ______
For Minors: Needs Parent Signature Parent Name:______Signature:______Date ______
Quintana Investigations
Security Consultants
6003 West Overland #105
Boise, Idaho 83709
208-429-6575 O
208-345-1172 F
208-631-1335 E
1-800-429-6575 NW
The Human Resources should need very little training to use this system. It is very important to stay current with Employment related law. We are members of the Chamber of Commerce and receive training from the State of Idaho as well as belonging to several associations that update us with changes in the law or court decisions that would affect background investigations. You should have a comprehensive policy in place that deals with background investigations. The one below we use with one of our vendors. We will customize the form to fit your standards.
Please Note: ALL items of pages 1-2 must be completed and submitted to the Director. Pages 3-6 remain with the individual.
Gem County Recreation District
BACKGROUND CHECK - RELEASE AUTHORIZATION FOR VOLUNTEERS.
1. In connection with my VOLUNTEERING, I understand that a consumer report or an investigative consumer report may be requested that will include information as to my character. I understand that as directed by Gem County Recreation District policy and consistent with the position I hold, you may be requesting information from public and private sources about my court records or criminal background.
2. I acknowledge that a telephonic facsimile (FAX) or photographic copy shall be as valid as the original. This release is valid for most federal, state and county.
3. I hereby authorize, without reservation, any law enforcement agency, institution, information service bureau, school, employer, reference or insurance company contacted by the Gem County Recreation District (208)365-5748 or its agent, to furnish the information described in paragraph 1.
4. The following information is required by law enforcement agencies and other entities for positive identification purposes when checking public records. It is confidential and will not be used for any other purposes. I hereby release all persons, agencies, and entities providing information or reports about me from any and all liability arising out of the requests for or release of any of the above mentioned information or reports.
Applicant’s full name (PLEASE PRINT)
Please print other names you have used
Address
City, State Zip CodePhone Number/Cell Number
Social Security Number Date of Birth / /
Name of area where you work with children
Signature Today’s Date
Quintana Investigations
Security Consultants
6003 West Overland #105
Boise, Idaho 83709
208-429-6575 O
208-345-1172 F
208-631-1335 E
1-800-429-6575 NW
Complete back of this form
Disclosure to Employee Regarding Procurement
Of a Consumer Report (Criminal Background Check)
In connection with your volunteering, we may procure a consumer report (such as a criminal background check) on you as part of the process of considering your candidacy as a volunteer. In the event that information from the report is utilized in whole or in part in making an adverse decision with regard to your potential assignment, before making the adverse decision, we will provide you with a copy of the consumer report and a description in writing of your rights under the law.
Please be advised that we may obtain an investigative report including information as to your criminal record. Please be advised that you have the right to request, in writing, within a reasonable time, that we make a complete and accurate disclosure of the nature and scope of the information requested. Such disclosure will be made to you within 5 days of the date on which we receive the request from you or within 5 days of the time the report was first requested.
The Fair Credit Reporting Act gives you specific rights in dealing with consumer reporting agencies. You will find these rights in the document A Summary of Your Rights. By your signature below, you hereby authorize us to obtain a criminal background check about you in order to consider you for employment.
This report will be processed by:
Quintana Investigations
6003 West Overland #105
Boise, Idaho 83709
208-429-6575
Applicant’s Full Name (PLEASE PRINT)
Applicant’s Address
City/State/Zip:
Social Security NumberDate of Birth
SignatureToday’s Date
Volunteer Coach Job Description
TITLE:Volunteer coach the Gem County Recreation District (GCRD)
DESCRIPTION:*Coach youth athletes of all ages.
*You will be considered a role model for 10-15 (depends on season) young athletes assigned to your team; therefore sportsmanship, fair play, and full participation are mandatory.
RESPONSIBILITIES:*Plan and supervise games, practices, and events.
*Communicate w/ your team as to practice times, game times, picture times and snack. If there are any schedule changes you need notify the families
*Supervise assistant coaches, managers, or team parents.
*Teach the young athlete the fundamentals of the sport.
*Encourage the involvement of the parents in the sport.
*Schedule and conduct parent and other necessary meetings.
*Provide a safe and fun environment for the children.
*Learn and follow all league rules, policies, and procedures.
*Give each player equal playing time.
*Put the feelings of the players ahead of your desire to win.
*Attend all league functions and participate in league activities.
*Maintain GCRD equipment and return at the end of the season.
*Work closely with GCRD staff to ensure policies are being observed.
*Must have at least one practice a week plus games. (Can be prior to game )
*Must turn in an end of the season evaluation to receive your free sports pass.
QUALIFICATIONS:*Successfully complete the application procedure and pass a background check.
*Attend any scheduled coaching clinics or meetings.
*Must be patient, especially with children.
*Be organized.
*Be dependable.
INFORMATION:As a volunteer coach, you are treated by local, state, and federal law as
being an unpaid employee of the agency in which you are associated with;
therefore, you must conduct yourself in the same manner as you would
your own job. In the same respect, you will receive the same treatment,
aside from compensation and benefits, as the employees of the Gem County Recreation District.
SUPERVISOR:Reports directly to the Recreation Coordinator.
*** Upon completion of the season and all coaching related criteria you will receive a certificate good for one free sports season through the GCRD. It can be used for any sport following the season you coached. ******
I agree that I have read and understand the above job description for a youth sports league coaching position, and that I accept the terms of the job description.
______
Applicant Signature Name (Printed)Date
Please note: Failure to sign this page will render the application incomplete and unacceptable.