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Based on your understanding of the Volunteer Coach Program, will you require any special accommodation to apply and/or participate as a volunteer?
Have you ever been convicted of a criminal offense (felony or misdemeanor), which has not been judicially ordered, sealed, expunged, or statutorily eradicated? (Omit convictions for marijuana-related offenses that are more than two years old, and misdemeanor convictions for which probation has been successfully completed or otherwise discharged and judicially dismissed under Penal Code section 1203.4.)
Note: No applicant will be denied a volunteer placement solely on the grounds of conviction of criminal offense. The nature of the offense, the date of the offense, the surrounding circumstances, the relevance of the offense to position(s) applied for and any other relevant factors are considered.
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I certify that all statements on this application are true and complete to the best of my knowledge. I hereby authorize the City of Palmdale to investigate any information contained in this application. I understand that as part of the final selection process I will be required to pass a livescan fingerprint scan submission via the California Department of Justice. I understand the information collected during this background check will be limited to that appropriate to determining my suitability for particular that information collected during the check will be kept confidential. I understand that false or misleading statements shall be sufficient grounds for disqualification from the City’s Volunteer Program. Further, I understand that as a volunteer, I am offering my services of my own free will without any expectation of compensation, benefits, or insurance of any kind.
I voluntarily agree to participate, or for my child to participate, in this program. I hereby waive, release, and hold harmless from any liability or claims for damages for personal injury, including death, as well as from claims for property damage which may arise in connection with the above-named activity, against the supervisor, the City of Palmdale and its elected and appointed officials, agents, and employees. As a parent/guardian, I hereby consent to treatment of my minor child for any and all medical procedures deemed necessary, as a result of accident or injury. I further agree to pay any and all costs incurred as a result of said treatment.
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