Volunteers

Background Check

* Indicates required field

Name *

First

Last

DATE OF BIRTH

Today's Date *

Month *

Day *

Year *

Address *

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Line 2

City

State

Zip Code

Country

Email *

Phone Number *

Drivers License Number (or State ID) *

Previous states resided in the last 5 years *

Special professional training, skills, hobbies *

Community affiliations (Clubs, Service Organizations, etc.) *

CRIMINAL BACKGROUND

Have you ever been convicted of any crime involving or against a minor? *

Yes No

Have you ever plead guilty to,been convicted of or involved with any other type of crime? *

Yes No

Have you ever been refused participation in any other youth programs? *

Yes No

If YES to ANY of the above, explain *

State ID Issued *

Occupation *

Previous/current volunteer experience *

Special Certification (i.e. CPR, Medical, etc.) *

Social Security Number *

Employer *

Employer's Address *

Line 1

Line 2

City

State

Zip Code

Country

By submitting this form, I hereby certify that all information provided in this application is true and complete to the best of my knowledge. If I am accepted as a volunteer, contractor, or employee, Robbins Park District may terminate or discontinue the relationship immediately if any false statements or material misrepresentations, whether written or verbal, are discovered.

As a condition of volunteering, contracting, or employment, I hereby authorize Robbins Park District to conduct a background check, which may include a review of database records including, but not limited to, sex offender registries, child abuse records, and criminal history records, in compliance with applicable child protection policies. I understand and agree that any appointment or engagement is contingent upon the park district receiving no inappropriate or disqualifying information through such background checks.

I hereby release and agree to hold harmless Robbins Park District, its officers, employees, volunteers, agents, and any other person or organization providing such information, from any liability arising from the background check process or related determinations.

I also understand that, regardless of any previous appointment, engagement, or employment, Robbins Park District is not obligated to appoint, hire, or retain me in any volunteer, contractor, or employment position. I understand that I may be subject to suspension, termination, or removal for violations of park district policies, procedures, standards, or principles.
Furthermore, I certify that all contact information provided herein is current and accurate, and I authorize Robbins Park District and its partners to use such contact information for communications, operational purposes, and promotional materials during the course of my volunteer service, contractual engagement, or employment.

Submit