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Lake Fenton Application Form Date ________________ Position: Cheer or Football (circle one) Title____________________________ (Head Coach, Assistant, Board Position) Full Legal Name of Applicant _______________________________________________ Other Names (Maiden, Alias etc) ____________________________________________ Address ________________________________________________________________ City __________________________________ State ____________ Zip ____________ Daytime Phone (____)__________________ Evening Phone (____)________________ Email Address ______________________________ Date of Birth__________________ Social Security Number _____________________________ Male _____ Female _____ Drivers License Number _______________ State ________ Expiration Date _________ Previous Address (List Address if not at current address for 5 years): Street _______________________________________________________ Apt # ______ City _________________________________ State __________ Zip _______________ Present Employer _____________________________________ Hire Date ___________ Employers Address _______________________________________________________ City _________________________________ State __________ Zip _______________ Position ________________________________________________________________ Name of Supervisor _______________________________________________________
References (List 3 not family relations) Name_______________________ Address______________________ Phone________ Name_______________________ Address______________________ Phone________ Name_______________________ Address______________________ Phone________ Have you ever been arrested, charged or convicted of a crime? No ______ Yes ______ If yes, please explain: ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ Have you ever had or do you currently have a problem with drugs and/or alcohol? No ______________ Yes _____________ If yes, please explain: ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ What is your motivation to volunteer for this position? ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ List any formal training that you have completed that is related to this position: ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ Do you have Automobile Insurance? Yes __________ No ________ Name of Company________________________________________________________ I understand and agree that: 1. This organization can deny any applicant for any reason or for no reason at all. 2. This application is valid for 1 (one) year and a new application has to be completed immediately thereafter. 3. By submitting this application I, the applicant, affirm that all the foregoing information I have provided is true and correct. 4. By submitting this application I, the applicant, agree (in return for being permitted to volunteer) that if any of the foregoing information is incorrect, I will forever indemnify and hold this organization harmless for any acts or omissions on my behalf as they relate to any incorrect information I have provided. 5. By submitting this application I, the applicant, voluntarily waive my privacy rights to the extent necessary for the youth organization to verify the foregoing information through any reasonable means, including, but not limited to local, state, national and international criminal background check(s) and to inform those within the organization who are responsible for accepting and/or supervising volunteers. Print Name ______________________________________________________________ Signature __________________________________________ Date_________________ Please submit completed form to Fred Carlton for Football (810-593-0007), Maggie Braun for Cheer (magalena@aol.com), or Mike Vance (810-750-3041). |