Dear Franklin Regional School District Volunteer: As per the Pennsylvania Child Protective Services Law, all volunteers need to submit valid (dated

Size: px
Start display at page:

Download "Dear Franklin Regional School District Volunteer: As per the Pennsylvania Child Protective Services Law, all volunteers need to submit valid (dated"

Transcription

1 Dear Franklin Regional School District Volunteer: As per the Pennsylvania Child Protective Services Law, all volunteers need to submit valid (dated within 60 months) clearances. The volunteer is responsible to purchase and submit clearances via the volunteer application prior to the expiration date (60 months). Failure to do so will result in you not being able to volunteer, in any capacity, at any school or activity. This is a statewide mandate which affects all school districts and businesses working within a district. We recommend you apply several weeks/months in advance of obtaining new clearances. Please see the attached Frequently Asked Question s (FAQ) for more information and to determine which clearances you need. 1. Volunteer Application: Please check all schools you are interested in volunteers in. 2. Child Abuse Clearance Cost: Free for volunteers Phone: or Online: Instant report online by going to Mail (may take several weeks to receive): Print the form by going to and mail it to the address on the form. 3. PA State Criminal History (PATCH) Clearance (No cost) Cost: Free for volunteers Phone: Online: Instant report online by going to Mail (may take several weeks to receive): Print the form by going to and mail it to the address on the form. 4. FBI Fingerprint Criminal Background Clearance OR Volunteer Residency Affidavit - FBI Clearance: You must obtain this if you will be responsible for the child s welfare, having direct volunteer contact with children, be unaccompanied with students or chaperone a field trip. See attached FAQ s for step-by-step registration instructions. You will receive an from the agendcy with a one-time useage link to print your clearance results. Cost: $22.60 Phone: Online: To register and schedule an appointment go to volunteer registration Service Code 1KG6Y3. Then take your registration form to the fingerprinting location you selected during registration. - Volunteer Residency Affidavit: This can be submitted as an alternative to submitting the FBI Clearance if you meet the following two criteria: You will always be volunteering directly under the supervision and direction of a school administrator, a teacher or other member of the school staff. You have never been convicted of a disqualifying crime in Pennsylvania, or the corresponding offenses under the laws of any other jurisdiction and that they have lived in the state of PA for 10 years or more. Print the Volunteer Residency Affidavit form by going to arances/volunteer%20residency%20affidavit%20-% pdf 5. Turberculosis (TB) Test: When required by the PA Department of Health, a TB test dated within 12 months must be provided. To access the Franklin Regional School District 916 Volunteer Policy please go to Please contact your School Secretary or frvolunteer@franklinregional.k12.pa.us with questions. Sincerely, Marlena K. Lang, Director of Human Resources

2 ÿ97 %&&' 12+3*&/ 8*3)2 <07=2: (&)*+,ÿ-./0.) 13.30; 9&)0/322:; D+3&=2:ÿ>?EÿF5>G 2/O./+2ÿ3O2ÿ2B0+.3*&/.)Eÿ+&S+0::*+0).:ÿ./Bÿ2T3:.+0::*+0).:ÿC:&P:.7;ÿ&Qÿ3O2ÿB*;3:*+3U HIJKLMN ÿviwxljywz ÿ8o2ÿ%&.:bÿ;0cc&:3;ÿ./bÿ2/+&0:.p2;ÿ3o2ÿc.:3*+*c.3*&/ÿ&qÿc.:2/3;rp0.:b*./;ÿ./bÿ+&770/*3,ÿ:2;*b2/3;ÿ3&.+3*&/;ÿ3o.3ÿ7.,ÿ=2ÿ.cc)*2bÿq&:ÿa*&).3*&/ÿ&qÿ%&.:bÿc&)*+*2;eÿ.b7*/*;3:.3*a2ÿ:2p0).3*&/;eÿ:0)2;eÿ./b C:&+2B0:2;U[>\ C.:3*+*C.3*&/ÿ*/ÿ3O2ÿ.+3*A*3*2;ÿ&Qÿ3O2ÿB*;3:*+3U[>\ ÿ8o2ÿ%&.:bÿb*:2+3;ÿ3o.3ÿ.)ÿa&)0/322:;ÿ;o.)ÿ=2ÿ*/q&:72bÿ&qÿ+&/b0+3ÿ3o.3ÿ*;ÿc:&o*=*32bÿ./bÿ3o2ÿb*;+*c)*/.:, ÿ8o2ÿ%&.:bÿ7.,ÿ.b&c3ÿ./bÿ2/q&:+2ÿ:2.;&/.=)2ÿ:0)2;ÿ./bÿ:2p0).3*&/;ÿp&a2:/*/pÿa&)0/322:;ÿ./bÿ3o2*: ;30B2/3;ÿ3O.3ÿ.:2ÿ+&/B0+*A2ÿ3&ÿ./ÿ2Q2+3*A2Eÿ;.Q2ÿ)2.:/*/Pÿ2/A*:&/72/3U[F\ 3O*;ÿ;2+3*&/a ÿvbicwÿsÿ./ÿ*/b*a*b0.)ÿ2*po322/ÿe>fgÿ,2.:;ÿ&qÿ.p2ÿ&:ÿ&)b2:u[h\ ÿ^n_ỳywyl`m ÿinjwy_yjkwyl`mÿsÿ:2q2:;ÿ3&ÿ3o2ÿ+o*)bÿ.=0;2ÿo*;3&:,ÿ+)2.:./+2ÿ;3.3272/3lÿ3o2ÿ;3.32ÿ+:*7*/.)ÿo*;3&:, ÿ8o2ÿq&)&]*/pÿ]&:b;ÿ./bÿco:.;2;eÿ]o2/ÿ0;2bÿ*/ÿ3o*;ÿc&)*+,eÿ;o.)ÿo.a2ÿ3o2ÿ72./*/pÿp*a2/ÿ3&ÿ3o27ÿ*/ =.+'P:&0/Bÿ+O2+'lÿ./Bÿ]O2:2ÿ.CC)*+.=)2Eÿ3O2ÿQ2B2:.)ÿ+:*7*/.)ÿO*;3&:,ÿ=.+'P:&0/Bÿ+O2+'Eÿ:2m0*:2Bÿ=, ;0C2:A*;*&/Eÿ72/3.)ÿO2.)3OÿB*.P/&;*;ÿ&:ÿ3:2.372/3Eÿ3:.*/*/Pÿ&:ÿ+&/3:&)ÿ&Qÿ.ÿ+O*)Bÿ*/ÿ)*20ÿ&QÿC.:2/3.)ÿ+.:2E 3O2ÿ6O*)Bÿ(:&32+3*A2ÿ12:A*+2;ÿn.]U[o\[p\ ;0C2:A*;*&/ÿ./Bÿ+&/3:&)U[h\ ÿ^yjnjwÿqlci`wnnjÿjl`wkjwÿsÿ3o2ÿ+.:2eÿ;0c2:a*;*&/eÿp0*b./+2ÿ&:ÿ+&/3:&)ÿ&qÿ+o*)b:2/ÿ./bÿ:&03*/2 ÿhnjml`ÿjnmkl`myrcnÿ_ljÿwxnÿjxycbsmÿtnc_kjnÿsÿ.ÿc2:;&/ÿ]o&ÿc:&a*b2;ÿc2:7./2/3ÿ&:ÿ327c&:.:,ÿ+.:2e ÿuliwỳnÿỳwnjkjwyl`ÿsÿ:2p0).:ÿ./bÿ:2c2.32bÿ+&/3.+3ÿ3o.3ÿ*;ÿ*/32p:.)ÿ3&ÿ.ÿc2:;&/v;ÿa&)0/322: */32:.+3*&/ÿ]*3Oÿ+O*)B:2/U[h\ A&)0/322:ÿQ&:ÿC0:C&;2;ÿ&Qÿ3O*;ÿC&)*+,U[?\ ÿwymywljÿxÿ.ÿc.:2/3rp0.:b*./eÿ.b0)3ÿ:2;*b2/3eÿ2b0+.3&:eÿ&q*+*.)ÿ&:ÿ&3o2:ÿ*/b*a*b0.)ÿ]o&ÿ*;ÿ/&3ÿ.ÿ;+o&&).+3*a*3,ÿ.3ÿ.ÿ;+o&&)eÿ=03ÿ]o&;2ÿ:&)2ÿ*;ÿ)2;;ÿ;0=;3./3*.)ÿ3o./ÿ]&0)bÿ=2ÿ;0q*+*2/3ÿ3&ÿ7223ÿ3o2ÿb2q*/*3*&/ÿ&q 27C)&,22ÿ&:ÿ*/B2C2/B2/3ÿ+&/3:.+3&:Eÿ./Bÿ]O&ÿA*;*3;ÿ.ÿ;+O&&)ÿ&:ÿ.32/B;ÿ&:ÿC.:3*+*C.32;ÿ*/ÿ./ÿ2A2/3ÿ&: :2;C&/;*=*)*3*2;U[h\ !" 02# ÿ

3 ÿh69ÿ357ÿijkÿ29>928ÿ7=ÿ>721/399:8ÿ.:9l /38C ÿf+'+gh*i&)ÿ&jÿk+lm&)lini'i*o 3;<9C ÿq(ir+'i)+l ÿh69ÿ/.<98ÿ7=ÿ.2ÿ>721/399:8ÿ86.2ÿu9ÿ81u<;390ÿ=7:ÿ.bb:7>.2ÿu?ÿ369ÿb1b9:;/39/09/3ÿ7:ÿ098;a/99c ÿt:;7:ÿ37ÿ.bb:7>.24ÿ.2ÿ>721/399:8ÿ86.2ÿ81u<;3ÿ369ÿ=7275;/aÿ;/=7:<.3;7/l ÿ !" 32#

4 5-.&DEFÿ K&ÿL, ÿH4:42>2;4ÿ856ÿM5-0;42261ÿ<ÿ=+,9+ÿ,1ÿ:ÿ14:42>2;4ÿ1=2:6,;Nÿ56ÿ:8,6>,;Nÿ4+2ÿ:OO-,9:;4 ÿ Q5-0;4226ÿ>014ÿ:-15ÿ10/>,4ÿ4+2ÿ85-5=,;Nÿ,;856>:4,5;WDEF %&ÿx2.26:-ÿ*6,>,;:-ÿ3,14567ÿi2o564ÿ<ÿ,1102.ÿ:4ÿ:;7ÿ4,>2ÿ1,;92ÿ4+2ÿq5-0;4226ÿ214:/-,1+2.ÿ621,.2;97& +:1ÿ;54ÿ/22;ÿ.,1P0:-,8,2.ÿ865>ÿ126Q,92ÿ/7ÿ62:15;ÿ58ÿ95;Q,94,5;ÿ58ÿ.21,N;:42.ÿ96,>,;:-ÿ582;121ÿ56 /2,;Nÿ-,142.ÿ:1ÿ4+2ÿO26O246:456ÿ,;ÿ:ÿ850;.2.ÿ62O564ÿ58ÿ9+,-.ÿ:/012&DRFDEFDSF., ÿ4+:4ÿO ÿ126Q,92ÿ:1ÿ:ÿQ5-0;4226& >:;;26ÿ1,>,-:6ÿ45ÿ4+:4ÿ012.ÿ856ÿ19+55-ÿ2>O-57221& ÿj;856>:4,5;ÿ10/>,42.ÿ/7ÿq5-0;42261ÿ,;ÿ:9956.:;92ÿ=,4+ÿ4+,1ÿo5-,97ÿ1+:-ÿ/2ÿ>:,;4:,;2.ÿ92;46:-7ÿ,;ÿ: Y+2ÿH0O26,;42;.2;4ÿ56ÿ.21,N;22ÿ1+:-ÿ62Q,2=ÿ4+2ÿ,;856>:4,5;ÿ:;.ÿ.2426>,;2ÿ,8ÿ4+2ÿ,;856>:4,5;ÿ,1 /7ÿ4+2ÿ19+55-ÿ,;ÿ=+,9+ÿ4+2ÿ140.2;4ÿ,1ÿ2;65-2.ÿ:;.ÿ599066,;Nÿ5;ÿ4+2ÿ19+55-[1ÿN650;.1Tÿ1+:-ÿ;54ÿ/2 9:62ÿ126Q,92ÿ56ÿ4+2ÿ140.2;4ÿ=,-ÿ54+26=,12ÿ/2ÿ621O5;1,/-2ÿ856ÿ4+2ÿ=2-8:62ÿ58ÿ:ÿ9+,-.&DEF 62P0,62.ÿ/7ÿ:;.ÿ,;ÿ:9956.:;92ÿ=,4+ÿ4+2ÿ62N0-:4,5;1ÿ:;.ÿN0,.:;92ÿ58ÿ4+2ÿ(2;;17-Q:;,:ÿL2O:64>2;4ÿ58 ÿy0/ ,1ÿy214 ÿ(6,56ÿ45ÿo:64,9,o:4,;nÿ,;ÿ140.2;4ÿ:94,q,4,21tÿq5-0;42261ÿ1+:-ÿ0;.26n5ÿ:ÿ4214ÿ856ÿ40/ ,1tÿ=+2; 62P0,62.ÿ45ÿ10/>,4ÿ9264,8,9:4,5;1ÿ2?92O4ÿ=+2;ÿ4+2ÿ2Q2;4ÿ56ÿ:94,Q,47ÿ,1ÿ856ÿ9+,-.62;ÿ,;ÿ4+2ÿ9:62ÿ58ÿ:ÿ9+,-.< ÿ)66214ÿ56ÿ*5;q,94,5;ÿi2o564,;nÿi2p0,62>2;41 ;:>2.ÿ:1ÿ:ÿO26O246:456ÿ,;ÿ:ÿ850;.2.ÿ56ÿ,;.,9:42.ÿ62O564ÿO0610:;4ÿ45ÿ4+2ÿ*+,-.ÿ(654294,Q2ÿH26Q,921ÿV:=& 32:-4+&D\FD%BF :;ÿ:66214ÿ56ÿ95;q,94,5;ÿ62p0,62.ÿ45ÿ/2ÿ62o5642.ÿ/7ÿ-:=ÿ56ÿ;54,8,9:4,5;ÿ4+:4ÿ4+2ÿq5-0;4226ÿ+:1ÿ/22; 4+2ÿH0O26,;42;.2;4ÿ56ÿ.21,N;22ÿ+:1ÿ:ÿ62:15;:/-2ÿ/2-,28ÿ4+:4ÿ4+2ÿQ5-0;4226ÿ=:1ÿ: ÿ856ÿ56ÿ+:1 56ÿ,;.,9:42.ÿ62O564Tÿ56ÿ+:1ÿO65Q,.2.ÿ=6,42;ÿ;54,92ÿ58ÿ109+ÿ ;92&DSF /22;ÿ95;Q,942.ÿ58ÿ:;ÿ582;12ÿ62P0,62.ÿ45ÿ/2ÿ62O5642.ÿ/7ÿ-:=Tÿ=:1ÿ;:>2.ÿ:1ÿ:ÿO26O246:456ÿ,;ÿ:ÿ850;.2. ÿx:,-062ÿ45ÿ:9906:42-7ÿ62o564ÿ109+ÿ ;921ÿ>:7ÿ10/]294ÿ4+2ÿq5-0;4226ÿ45ÿ.,19,o-,;:67ÿ:94,5;ÿ0oÿ45 ÿy+2ÿh0o26,;42;.2;4ÿ56ÿ.21,n;22ÿ1+:-ÿ,>>2.,:42-7ÿ62p0,62ÿ:ÿq5-0;4226ÿ45ÿ10/>,4ÿ;2=ÿ9264,8,9:4,5;1ÿ,8 >:^2ÿ:ÿ62O564ÿ58ÿ101O2942.ÿ9+,-.ÿ:/012ÿ,;ÿ:9956.:;92ÿ=,4+ÿ:OO-,9:/-2ÿ-:=Tÿ_5:6.ÿO5-,97Tÿ:;. :.>,;,146:4,Q2ÿ62N0-:4,5;1&D%%FD%GF :;.ÿ,;9-0.,;nÿ.2;,:-ÿ58ÿq5-0;4226ÿ126q,92ÿ:;.ÿ96,>,;:-ÿo ,5;&dsf ÿ*+,-.ÿ)/012ÿi2o564,;n ÿ)-ÿq5-0;42261ÿ=+5ÿ+:q2ÿ62:15;:/-2ÿ9:012ÿ45ÿ101o294ÿ4+:4ÿ:ÿ9+,-.ÿ,1ÿ4+2ÿq,94,>ÿ58ÿ9+,-.ÿ:/012ÿ1+:- ÿh0o26q,1,5; ÿ !" #2$

5 %&'(ÿ*+,-./001ÿ2(&,ÿ30ÿ-.401ÿ/(0ÿ2-501*626+.ÿ+7ÿ&ÿ40268.&/04ÿ2'(++,ÿ&496.62/1&/+1:ÿ/0&'(01ÿ+1ÿ&.+/( ÿ+7ÿ/(0ÿ2'(++,ÿ2/&7; ÿ<1&6.6.8 /1&6.6.8;DEFGDEHGDEIGDEJG 04-'&/6+.&,ÿ6.2/6/-/6+.2:ÿ' &/6+.ÿ2(&,ÿ30ÿ86*0.ÿ/+ÿB(6'(ÿ*+,-./0012ÿ2(+-,4ÿ&,2+ÿ10'06*0ÿ/(&/ ÿk /6&,6/> ÿ=+,-./0012ÿ2(&,ÿ&/0.4ÿ+160./&/6+.ÿ&.4ÿ/1&6.6.8ÿ :ÿ&2ÿ& &/0ÿ/+ÿ/(0ÿ.&/-10ÿ+7ÿ/(061 &''+14&.'0ÿB6/(ÿ462/16'/ÿ5+,6'602ÿ&.4ÿ51+'04-102ÿ&.4ÿ&55,6'&3,0ÿ,&B;ÿN7ÿ&ÿ*+,-./001ÿ(&2ÿA-02/6+.2ÿ&3+-/ ÿ%p', /(0ÿ' /6&,6/>ÿ+7ÿ2/-40./ÿ6.7+19&/6+.:ÿ/(0ÿ*+,-./001ÿ2(+-,4ÿ'+.2-,/ÿB6/(ÿ/(0ÿ3-6,46.8ÿ516.'65&,;DEOG B6/(ÿ&''022ÿ/+ÿ' /6&,ÿ2/-40./ÿ6.7+19&/6+.ÿ2(&,ÿ9&6./&6.ÿ/(0ÿ' /6&,6/>ÿ+7ÿ/(&/ÿ6.7+19&/6+.ÿ6. 40/ ÿ/(&/ÿ2-'(ÿ&''022ÿ62ÿ.0'022&1>ÿ7+1ÿ/(0ÿ*+,-./001ÿ/+ÿ7-,76,ÿ(62M(01ÿ ,6/602;ÿ=+,-./0012 ÿl+ÿ*+,-./001ÿ2(&,ÿ30ÿ50196/04ÿ&''022ÿ/+ÿ' /6&,ÿ2/-40./ÿ6.7+19&/6+.ÿ-.,022ÿ/(0ÿ2-501*62+1ÿ(&2 ÿ=+,-./0012ÿ+7ÿ3++2/01ÿ+18&.6u&/6+.2ÿ&/ÿ2'(++,ÿ0*0./2:ÿ &.'02ÿ+1ÿ25+1/6.8ÿ0*0./2ÿb(6'(ÿ&10ÿ+50. /+ÿ/(0ÿ80.01&,ÿ5-3,6'ÿ&10ÿ0p095/ÿ71+9ÿ/(0ÿ10a /2ÿ+7ÿ/(62ÿ5+,6'>; '(0'Rÿ5-12-&./ÿ/+ÿS'(++,ÿK+40ÿS0'/6+.ÿETEEEÿ&10ÿ0P095/ÿ71+9ÿ/(0ÿ10A /2ÿ+7ÿ/(62ÿ5+,6'>; ÿv&10./2mw-&146&.2ÿ+7ÿ462/16'/ÿ2/-40./2ÿb(+ÿ&10ÿ51020./ÿ+.ÿ462/16'/ÿ51+501/>ÿ+1ÿ6.ÿ2'(++,ÿ3-6,46.82ÿ+1ÿ&/ ÿq,ÿ462/16'/ÿ2/&7:ÿ&496.62/1&/+12:ÿ'+&'(02:ÿ&.4ÿ+/(01ÿ095,+>002ÿ10a-6104ÿ/+ÿ ÿ&ÿ3&'r '(++,ÿ0*0./2ÿ2+,0,>ÿ7+1ÿ ÿ4610'/,>ÿ10,&/04ÿ/+ÿ/(061ÿ+B.ÿ'(6,4:ÿ2-'(ÿ&2ÿ5&10./M/0&'(01 ÿx6&36,6/>ÿn.2-1&.'0 ÿ<(0ÿ462/16'/ÿ9&>ÿ51+*640ÿ,6&36,6/>ÿ6.2-1&.'0ÿ'+*01&80ÿ7+1ÿ*+,-./0012ÿ& &/0ÿ/+ÿ/(0ÿ.&/-10ÿ+7ÿ/(061 1+,02ÿ&.4ÿ/(0ÿ162Rÿ9&.&8090./ÿ.0042ÿ+7ÿ/(0ÿ462/16'/; ' '02ÿ+1ÿB&/'(6.8ÿ/(061ÿ'(6,4ÿ ÿ+1ÿ'+950/0ÿ6.ÿ2'(++,ÿ&'/6*6/602ÿ&10ÿ0P095/ÿ71+9ÿ/(0 10A /2ÿ+7ÿ/(62ÿ5+,6'>; &-/(+16U04ÿ6.ÿ&4*&.'0ÿ3>ÿ/(0ÿS-5016./0.40./ÿ+1ÿ ; ÿ=+,-./0012ÿ9&>ÿ30ÿ ÿ7+1ÿ0p50.202ÿ6.'-1104ÿ6.ÿ/(0ÿ'+-120ÿ+7ÿ/(061ÿ*+,-./001ÿ201*6'0ÿ+.,>ÿb(0. ÿq'r.+b, / ÿ%&'(ÿ*+,-./001ÿ2(&,ÿ&7619ÿ6.ÿb16/6.8ÿ/(&/ÿ2m(0ÿ(&2ÿ300.ÿ51+*6404ÿb6/(ÿ&ÿ'+5>ÿ+7:ÿ(&2ÿ10&4: /&.42ÿ&.4ÿ&81002ÿ/+ÿ'+95,>ÿB6/(ÿ/(62ÿ5+,6'>; ÿ !" #2$

6 ÿ97 $%&'(,*ÿ.2(*ÿ3,- )*ÿ,-ÿ.*/*ÿ0)1 7*ÿ.2(*ÿ819 4*ÿ,4ÿ.'*ÿ5*/*6*ÿ7414 -*ÿ,4ÿ.'*ÿ5*/*6*ÿ74-- 0*ÿ,4ÿ.'*ÿ5*/*6*ÿ74--*, 9*ÿ,4ÿ.'*ÿ5*/*6*ÿ74--*4 ),*ÿ.2(*ÿ317 3*ÿ,4ÿ.'*ÿ5*/*6*ÿ74--*- )4*ÿ.2(*ÿ),4 8*ÿ,-ÿ.*/*ÿ)-)3 )-*ÿ.2(*ÿ),4*) )1*ÿ,3ÿ.6ÿ52:%ÿ,4*-- )0*ÿ.2(*ÿ),4*, ))*ÿ,4ÿ.'*ÿ5*/*6*ÿ74)) )7*ÿ.2(*ÿ,)7,4ÿ.'*ÿ5*/*6*ÿ741)ÿ%;ÿ<%= !" #2#

7 DISCLOSURE STATEMENT APPLICATION FOR VOLUNTEERS Required by the Child Protective Service Law 23 Pa. C.S. Section (Relating to volunteers having contact with children) I swear/affirm that I am seeking a volunteer position and AM NOT required to obtain a clearance through the Federal Bureau of Investigation, as: the position I am applying for is unpaid; and I have been a resident of Pennsylvania during the entirety of the previous ten-year period. I swear/affirm that I have not been named as a perpetrator of a founded report of child abuse within the past five (5) years as defined by the Child Protective Services Law. I swear/affirm that I have not been convicted of any of the following crimes under Title 18 of the Pennsylvania consolidated statues or of offenses similar in nature to those crimes under the laws or former laws of the United States or one of its territories or possessions, another state, the District of Columbia, the Commonwealth of Puerto Rico or a foreign nation, or under a former law of this Commonwealth. Chapter 25 (relating to criminal homicide) Section 2702 (relating to aggravated assault) Section 2709 (relating to stalking) Section 2901 (relating to kidnapping) Section 2902 (relating to unlawful restraint) Section 3121 (relating to rape) Section (relating to statutory sexual assault) Section 3123 (relating to involuntary deviate sexual intercourse) Section (relating to sexual assault) Section 3125 (relating to aggravated indecent assault) Section 3126 (relating to indecent assault) Section 3127 (relating to indecent exposure) Section 4302 (relating to incest) Section 4303 (relating to concealing death of child) Section 4304 (relating to endangering welfare of children) Section 4305 (relating to dealing in infant children) Section 5902(b) (relating to prostitution and related offenses) Section 5903(c) (d) (relating to obscene and other sexual material and performances) Section 6301 (relating to corruption of minors) Section 6312 (relating to sexual abuse of children), or an equivalent crime under Federal law or the law of another state. I have not been convicted of a felony offense under Act (relating to the controlled substance, drug device and cosmetic act) committed within the past five years. I understand that I shall not be approved for service if I am named as a perpetrator of a founded report of child abuse within the past five (5) years or have been convicted of any of the crimes listed above or of offenses similar in nature to those crimes under the laws or former laws of the United States or one of its territories or possessions, another state, the District of Columbia, the Commonwealth of Puerto Rico or a foreign nation, or under a former law of this Commonwealth. I understand that if I am arrested for or convicted of an offense that would constitute grounds for denying participation in a program, activity or service under the Child Protective Services Law as listed above, or am named as perpetrator in a founded or indicated report, I must provide the administrator or designee with

8 written notice not later than 72 hours after the arrest, conviction or notification that I have been listed as a perpetrator in the Statewide database. I understand that if the person responsible for employment decisions or the administrator of a program, activity or service has a reasonable belief that I was arrested or convicted for an offense that would constitute grounds for denying participation in a program, activity or service under the Child Protective Services Law, or was named as perpetrator in a founded or indicated report, or I have provided notice as required under this section, the person responsible for employment decisions or administrator of a program, activity or service shall immediately require me to submit current clearances obtained through the Department of Human Services, the Pennsylvania State Police, and the Federal Bureau of Investigation, as appropriate. The cost of clearances shall be borne by the employing entity or program, activity or service. I understand that if I willfully fail to disclose information required above, I commit a misdemeanor of the third degree and shall be subject to discipline up to and including denial of a volunteer position. I understand that the person responsible for employment decisions or the administrator of a program, activity or service is required to maintain a copy of my clearances. I hereby swear/affirm that the information as set forth above is true and correct. I understand that false swearing is a misdemeanor pursuant to Section 4903 of the Crimes Code. Date Printed Name Signature

9 Child Protective Services Law Update Frequently Asked Questions Question 1 Answer 1 Question 2 Answer 2 If I have applied for my clearances but have not received all of them back, and my expiration date has passed. What happens? School Employees/Contractors: Contact Human Resources (HR) immediately. Depending on the amount of time that has transpired you may be placed on an unpaid suspension until you submit your clearances to HR. Volunteers: You must submit current clearances prior to volunteering. How do I apply for the required clearances? Below you will find the necessary web links and instructions for the clearances: 1. Child Abuse Clearance Cost - $8.00 Employees; Free for volunteers Phone: or Online: Instant report online with a credit card by going to OR Mail: Click the following link to print the form and mail it to the address provided on the form with an $8.00 money order payable (employees only, free for volunteers) to the Department of Public Welfare. This will take several weeks to process and receive the clearance in the mail PA State Criminal History (PATCH) Clearance Cost $22.00 Employees; Free for volunteers Phone: Online: Instant report online with a credit card by going to 3. FBI Fingerprint Criminal Background Clearance Cost $22.60 Phone Online: To register and schedule an appointment go to and enter one of the Service Codes listed below. Then take your registration form to the fingerprinting location you selected during registration. 1KG6XN 1KG6Y3 Service Code PA PDE School District Employee Service Code PA PDE Volunteer See the attachment at the end of these FAQ s for step-by-step instructions Question 3 Answer 3 Question 4 Answer 4 Who pays for the clearances? It is the responsibility of the employee/volunteer/contractor to pay for their clearances. Volunteers are eligible for a free child abuse clearance and PA State Criminal History Clearance. Who needs to apply for clearances? Anyone working as an employee for the district, individuals performing work for the district as a contractor or individuals acting as a volunteer for the district. As a general rule of thumb this includes anyone who may have direct access to district students and facilities and are representing the district. (Examples: Field Trip Chaperone, Activity Advisor, Recess or Library Aides, Assisting in classroom celebrations, School Assemblies/Concerts, Collecting tickets at sporting events, working in concession stands, participating in career day, Substitutes, Coaches, School Board Members, Professional and Support Staff, Tutors, Bus Drivers, Cafeteria Workers, PTO volunteers, Homebound Instructors and Club Advisors.)

10 Question 5 Answer 5 Question 6 Answer 6 How do I know if my clearances have expired? The date on the clearance must be within 60 months. Can I use my free volunteer clearances for employment? No, the free clearances cannot be turned in for employment. Volunteer Specific Frequently Asked Question s Question 7 If a parent or grandparent wants to attend a school play or breakfast hosted by the school district, do they need to have clearances? Answer 7 The attendee will not need clearances because they were invited by the school to either watch their child perform or socialize with their child as they eat. The attendee in this case is not volunteering. However, a District employee must remain with the guest at all times. Question 8 Answer 8 Do I need clearances to attend classroom celebrations/parties? If the attendee was invited by the school to socialize with their child during the event, the attendee in this case is not volunteering. However, a District employee must remain with the guest at all times. If an individual volunteers to assist with the coordination or running of such events, then the individual must complete the required paperwork and provide clearances. Question 9 Answer 9 If I strictly volunteer in the classroom and I am not chaperoning a field trip, do I need the FBI Clearance? Individuals volunteering in a supervised classroom can sign the Volunteer Residency Affidavit, if eligible OR they can submit the FBI clearance. Individuals volunteering in an unsupervised classroom or chaperoning a field trip must submit the FBI clearance. Question 10 What is a Volunteer Residency Affidavit and can I submit one? Answer 10 A Volunteer Residency Affidavit form can be submitted as an alternative to submitting the FBI Clearance if you meet the following two criteria: 1. You will always be volunteering directly under the supervision and direction of a school administrator, a teacher or other member of the school staff. 2. You have never been convicted of a disqualifying crime in Pennsylvania, or the corresponding offenses under the laws of any other jurisdiction and that they have lived in the state of PA for 10 years or more. Question 11 Answer 11 Question 12 Answer 12 Question 13 Answer 13 Question 14 If I am interested in volunteering and have not completed the clearance and application process, am I permitted a guest pass? No, although this was traditionally acceptable in the past, we are no longer able to accommodate this request. If you have applied for the clearances and have not received them back please contact HR. If a volunteer is scheduled to assist the coach during athletic practices, do they need clearances? Yes, the volunteer needs to provide clearances because they may be with students unsupervised. If a parent obtains clearances but can no longer continue to finish out the year because of family emergencies, do they need new clearances during the following year? If the clearances are within 60 months, they do not need to resubmit clearances. If the clearances expire during this timeframe, they will need to submit current clearances. If an employee or substitute of the district is interested in volunteering, are they required to submit clearances again?

11 Answer 14 Question 15 Answer 15 Question 16 Answer 16 Question 17 Answer 17 Question 18 Answer 18 Question 19 Answer 19 District employees must have current clearances for their district position which satisfies the requirements for Child Protective Services Law. They do not need to submit them again. Can an employee from another district volunteer without new clearances? If they are a volunteer they must submit current clearances dated within 60 months. What if my current employer requires clearances, but they are not the same as the Child Protective Services Law? PA Code mandates the clearances we are allowed to accept, please see question 2. Please note - active duty police officers do not need to obtain/submit clearances to volunteer. Do I need to submit the paperwork or clearances if I want to assist with PTO-sponsored events that are held outside of the school day (e.g. Fun Fest, basketball nights, ice cream socials, etc.)? Clearances are only required if it is a school sponsored event. However, in general it is good practice to provide clearances to the district. I am a volunteer and only help on committees, I do not go into classrooms; do I have to get clearances? Yes, as there is the possibility that a volunteer will be in direct contact with student. I am a coach that works during the baseball season only, do the same rules apply to me? If it is a PAID coaching position; please comply with the guidelines established for all district employees. If this is a VOLUNTEER coaching position, then the rules for volunteers apply to the assignment.

12 FBI FINGERPRINT CLEARANCE Effective November 28, 2017 the PDE has changed vendors for FBI fingerprint clearance processing from Cogent to IDEMIA. Cost is $22.60 Registration is required prior to having fingerprints taken. 1. Go to IDEMIA s website: 2. Enter Service Code PA PDE School District Employee: 1KG6XN PA PDE Volunteer: 1KG6Y3 3. Press Go Check to make sure it says Pennsylvania PDE School Districts or Pennsylvania PDE Volunteer. If it is incorrect click back to home. Registrations under the wrong code are not transferable. 4. Select Schedule or Manager Appointment 5. Enter Legal Name, Date of Birth, Method of Contact ( required). Click next.

13 6. Agency Identifiers: Create a Security Question and Answer (notate for future reference). Click next. 7. Enter Citizenship Information. Click next. 8. Enter answers to Personal Questions. Franklin Regional School District currently does not have authorization/coupon codes. Click next. 9. Enter Personal Information. Click next.

14 10. Enter Mailing Address. Click next. This is where your unofficial report will be mailed to. 12. Choose Document that you will bring with. Click next. 13.Location: Enter your zip code and click search to display locations near you. Click on the location and then next to select. 14. Schedule Appointment by selecting date and time. Click submit. 15. Click print status in upper right hand corner to print your registration form that you will take with you to your appointment. Payment is processed when prints are taken. Please read the registration form as it contains important information that you will need to know when you go get your fingerprints scanned. 16.Click done. You will receive a confirmation . Provide UE ID from your registration form to employer once fingerprints have been scanned.

Volunteer Manual. West Jefferson Hills School District

Volunteer Manual. West Jefferson Hills School District Volunteer Manual West Jefferson Hills School District Thank you for taking time to share your gifts and talents with the students of the West Jefferson Hills School District. By volunteering, you join

More information

VOLUNTEER MANUAL PLEASE READ THIS MANUAL AND OBTAIN ALL REQUIREMENTS BEFORE RETURNING YOUR COMPLETED PACKET TO THE DISTRICT ADMINISTRATION OFFICE.

VOLUNTEER MANUAL PLEASE READ THIS MANUAL AND OBTAIN ALL REQUIREMENTS BEFORE RETURNING YOUR COMPLETED PACKET TO THE DISTRICT ADMINISTRATION OFFICE. VOLUNTEER MANUAL Due to the requirements set by Pennsylvania State Law, ALL Susquehanna Township School District Volunteers must be registered with the Volunteer Program. This Volunteer Manual contains

More information

Mechanicsburg Area School District. Volunteer Handbook. 100 E. Elmwood Avenue 2 nd Floor

Mechanicsburg Area School District. Volunteer Handbook. 100 E. Elmwood Avenue 2 nd Floor Mechanicsburg Area School District Volunteer Handbook Mechanicsburg Area SD 100 E. Elmwood Avenue 2 nd Floor Mechanicsburg, PA 17055 Phone: 717.691.4500 Fax: 717.691.3228 Website: www.mbgsd.org Mechanicsburg

More information

No AN ACT. Providing for Statewide nurse aide training programs relating to nursing facilities.

No AN ACT. Providing for Statewide nurse aide training programs relating to nursing facilities. SESSION OF 1997 Act 1997-14 169 HB 133 No. 1997-14 AN ACT Providing for Statewide nurse aide training programs relating to nursing facilities. The General Assembly finds and declares that nurse aides in

More information

NURSING REVIEW BOARD

NURSING REVIEW BOARD NURSING REVIEW BOARD I. Introduction The following procedure outlines the process to be followed in all cases where criminal findings are found in the background checks for prospective and current Nursing

More information

Fox Chapel Area School District School Volunteer Manual

Fox Chapel Area School District School Volunteer Manual Fox Chapel Area School District School Volunteer Manual Manual includes school volunteer application and directions for completing the required clearances. Fox Chapel Area School District Volunteer Application

More information

Fox Chapel Area School District School Volunteer Manual

Fox Chapel Area School District School Volunteer Manual Fox Chapel Area School District School Volunteer Manual Manual includes school volunteer application and directions for completing the required clearances. Fox Chapel Area School District greatly appreciates

More information

Volunteer Application

Volunteer Application Volunteer Application Applicant Information First Name: Middle Initial: Last Name: Address: City: State: Zip: Home Phone: Cell Phone: Email: Occupation: Special Skills: Volunteer Preferences Have you previously

More information

Nurse Aide Training Program. ADMISSION & REQUIREMENT PACKET 275 Swamp Road Newtown, PA

Nurse Aide Training Program. ADMISSION & REQUIREMENT PACKET 275 Swamp Road Newtown, PA Nurse Aide Training Program ADMISSION & REQUIREMENT PACKET 275 Swamp Road Newtown, PA 18940 215-968-8482 www.bucks.edu/nurseaide WELCOME TO BUCKS COUNTY COMMUNITY COLLEGE NURSE AIDE TRAINING PROGRAM A

More information

Crime Identification Bureau (CIB) Background Checks. Bureau for Children and Families. Policy Manual. Chapter December 2005

Crime Identification Bureau (CIB) Background Checks. Bureau for Children and Families. Policy Manual. Chapter December 2005 Crime Identification Bureau (CIB) Background Checks Bureau for Children and Families Policy Manual Chapter 2000 December 2005 Table of Contents 1. Introduction... 2 2. Definitions... 3 3. Persons Required

More information

Policy S-2 FLORIDA STATE UNIVERSITY COLLEGE OF NURSING Page 1 of 2 TITLE: CRIMINAL BACKGROUND CHECK

Policy S-2 FLORIDA STATE UNIVERSITY COLLEGE OF NURSING Page 1 of 2 TITLE: CRIMINAL BACKGROUND CHECK Policy S-2 FLORIDA STATE UNIVERSITY COLLEGE OF NURSING Page 1 of 2 TITLE: POLICY: CRIMINAL BACKGROUND CHECK The College of Nursing requires all students to have a Criminal Background Check on file at the

More information

Information in State statutes and regulations relevant to the National Background Check Program: Arkansas

Information in State statutes and regulations relevant to the National Background Check Program: Arkansas Information in State statutes and regulations relevant to the National Background Check Program: Arkansas This document describes what was included as of December 2010 in Arkansas statutes and regulations

More information

NOTE: This is an 8-page document Read ALL!!!

NOTE: This is an 8-page document Read ALL!!! NOTE: This is an 8-page document Read ALL!!! PRE-SERVICE TRAINEES BASIC TRAINING PROGRAM Act 120 - Municipal Police Officers' Education and Training Commission For admission to the HACC Central Pennsylvania

More information

Red Oak Elementary Volunteer Information

Red Oak Elementary Volunteer Information Red Oak Elementary 2016-17 Volunteer Information Welcome to a new school year! We invite you to join our volunteer team in supporting the students and staff at Red Oak. Volunteers play an essential role

More information

NJ CRIMINAL HISTORY INSTRUCTIONS

NJ CRIMINAL HISTORY INSTRUCTIONS NJ CRIMINAL HISTORY INSTRUCTIONS New Jersey Criminal History Information If... *You have never been fingerprinted for Public School Employment, or *You were fingerprinterd before February 21, 2003... You

More information

Volunteers in Schools

Volunteers in Schools REGULATION MONTGOMERY COUNTY PUBLIC SCHOOLS Related Entries: Responsible Offices: ABA, ABA-RB, ABC, ABC-RA, CNA, CNA-RA, COA-RB, EIB- RA, GDA-RB, IPD-RA, JHC, JHC-RA Chief Academic Officer Deputy Superintendent

More information

If you have any questions, please direct them to the District Volunteer Office at (916)

If you have any questions, please direct them to the District Volunteer Office at (916) Dear Volunteer, We are pleased that you have decided to participate in the Sacramento City Unified School District (SCUSD) Volunteer Program! As parents, grandparents, neighbors and community members you

More information

Naples Middle. High School

Naples Middle. High School Naples Middle High School PRIVACY ACT STATEM ENT AUTHORITY: Section 113 of title 10 (Secretary of Defense),section 13041of title 42 USC 13041(Crime Control Act of 1990), and section 552a of title 5 (Privacy

More information

Football & Cheerleading. Youth Sports Coaches Volunteer Application

Football & Cheerleading. Youth Sports Coaches Volunteer Application Football & Cheerleading Youth Sports Coaches Volunteer Application YOUTH SPORTS VOLUNTEER JOB DESCRIPTION TITLE: DESCRIPTION: Volunteer Coach for Gainesville Parks and Recreation Agency. *Coach of male

More information

New Jersey Motor Vehicle Commission

New Jersey Motor Vehicle Commission Instructor License Type & Number New Jersey REMEDIAL DRIVER EDUCATION PROGRAM INITIAL INSTRUCTOR LICENSE APPLICATION Official Use Only P.O. Box 170 Trenton, New Jersey 08666-0170 (609) 292-6500 ext.5094

More information

Technical Assistance Paper

Technical Assistance Paper FLORIDA DEPARTMENT OF EDUCATION DPS: 2013-97 Date: July 18, 2013 Dr. Tony Bennett Commissioner of Education Technical Assistance Paper Related to the Background Screening Requirements of Noninstructional

More information

Volunteer Application Packet

Volunteer Application Packet Volunteer Application Packet Thank you for your interest in the TechTutor Volunteer Program. This Application Packet contains the Application Checklist, and Request for Criminal History & Disclosure forms.

More information

LPN to RN ADMISSION REQUIREMENTS

LPN to RN ADMISSION REQUIREMENTS LPN to RN ADMISSION REQUIREMENTS Students must turn in a complete application packet in a plain manila envelope to a Nursing Program Advisor, Room 191-B, prior to the listed application deadlines. Incomplete

More information

Application for Administrative Position for

Application for Administrative Position for Application for Administrative Position for For information, please contact: David N. Branch, Muskingum Valley Educational Service Center Muskingum Valley ESC 205 N. Seventh St., Zanesville, OH 43701 Phone:

More information

(e) Revocation is the invalidation of any certificate held by the educator.

(e) Revocation is the invalidation of any certificate held by the educator. Effective October 15, 2009 505-6-.01 THE CODE OF ETHICS FOR EDUCATORS (1) Introduction. The Code of Ethics for Educators defines the professional behavior of educators in Georgia and serves as a guide

More information

WESTMINSTER POLICE DEPARTMENT

WESTMINSTER POLICE DEPARTMENT WESTMINSTER POLICE DEPARTMENT CITIZENS ACADEMY WESTMINSTER CITIZENS POLICE ACADEMY The Westminster Police Department will be hosting the Citizens Police Academy beginning January 24 th, 2018. The class

More information

Sign and return included forms. (Authorization to Release Information Form, Background Check Form and Vehicle Use Agreement)

Sign and return included forms. (Authorization to Release Information Form, Background Check Form and Vehicle Use Agreement) To: Employees with Conditional Offers of Employment Re: Background Checks All offers of employment or participation in any activity involving minors in a University sponsored program with The University

More information

BACKGROUND CHECK PROGRAM

BACKGROUND CHECK PROGRAM BACKGROUND CHECK PROGRAM Effective July 1, 2018 I. PURPOSE OF BACKGROUND CHECK The purpose of the Department of Recreation and Parks Background Check Program is to ensure that every individual who interacts

More information

Sign and return included forms. (Background Check Form, Authorization to Release Information Form, and Vehicle Use Agreement)

Sign and return included forms. (Background Check Form, Authorization to Release Information Form, and Vehicle Use Agreement) To: Employees with Conditional Offers of Employment Re: Background Checks All offers of employment or participation in any activity involving minors in a University sponsored program with The University

More information

Dear PN Applicant. Sincerely, The PN Program Faculty North Arkansas College

Dear PN Applicant. Sincerely, The PN Program Faculty North Arkansas College Dear PN Applicant We are happy you are considering the Practical Nursing Program at North Arkansas College. The PN Program has been granted full approval by the Arkansas State Board of Nursing and traditionally

More information

Uniform Employment Application for Nurse Aide Staff

Uniform Employment Application for Nurse Aide Staff Uniform Employment Application for Nurse Aide Staff This application form is required by Title 63 O.S. Section 1-1950.4 of state law and by the Oklahoma State Board of Health Rules OAC 310-2-15-3. This

More information

Employer Instructions for Use ODH Form 805 Uniform Employment Application for Nurse Aide Staff

Employer Instructions for Use ODH Form 805 Uniform Employment Application for Nurse Aide Staff Effective November 1, 2012 Employer Instructions for Use ODH Form 805 Uniform Employment Application for Nurse Aide Staff Purpose This form is to be used by employers as the only employment application

More information

HEALTH GENERAL PROVISIONS CAREGIVERS CRIMINAL HISTORY SCREENING REQUIREMENTS

HEALTH GENERAL PROVISIONS CAREGIVERS CRIMINAL HISTORY SCREENING REQUIREMENTS TITLE 7 CHAPTER 1 PART 9 HEALTH HEALTH GENERAL PROVISIONS CAREGIVERS CRIMINAL HISTORY SCREENING REQUIREMENTS 7.1.9.1 ISSUING AGENCY: New Mexico Department of Health. [7.1.9 1 NMAC - Rp, 7.1.9.1 NMAC, 01/01/06]

More information

PRACTICAL NURSING APPLICATION PROCEDURE AND DEADLINE:

PRACTICAL NURSING APPLICATION PROCEDURE AND DEADLINE: 1 APPLICATION PROCEDURE AND DEADLINE: Classes are admitted in August and January. Class size is limited, and all applicants are not accepted for participation. All applicants will have an equal opportunity

More information

BEN CLARK TRAINING CENTER RIVERSIDE COUNTY SHERIFF S DEPARTMENT DAVIS AVENUE SUITE A, RIVERSIDE, CA

BEN CLARK TRAINING CENTER RIVERSIDE COUNTY SHERIFF S DEPARTMENT DAVIS AVENUE SUITE A, RIVERSIDE, CA COURSE TITLE: CITIZENS ACADEMY OVERVIEW: Attendees will learn the daily operations of the Sheriff s Department, along with policies and procedures within law enforcement. Various topics will include the

More information

Live Scan Fingerprinting

Live Scan Fingerprinting Live Scan Fingerprinting Background Legislation was passed in late 1997 that the California Department of Justice (DOJ) developed an automated background check process that requires digitized fingerprints

More information

New Jersey Motor Vehicle Commission

New Jersey Motor Vehicle Commission New Jersey STATE OF NEW JERSEY P.O. Box 170 Trenton, New Jersey 08666-0170 (609) 292-6500 ext. 5014 FAX# 609-292-4400 mvcblsprocessing@mvc.nj.gov Chris Christie Governor Kim Guadagno Lt. Governor Raymond

More information

Practical Nursing Program Information and Application Packet

Practical Nursing Program Information and Application Packet Practical Nursing Program Information and Application Packet The UACCB Practical Nursing Program is approved by the Arkansas State Board of Nursing, University Tower Bldg., 1123 South University, Suite

More information

Directions for Submitting a Complete Application for the Precertification Nursing Assistant Training Course Fall 2018

Directions for Submitting a Complete Application for the Precertification Nursing Assistant Training Course Fall 2018 Directions for Submitting a Complete Application for the Precertification Nursing Assistant Training Course Fall 2018 Application Acceptance: May 1 May 31, 2018 All applications are evaluated for the elements

More information

Uniform Employment Application for Nurse Aide Staff

Uniform Employment Application for Nurse Aide Staff This application form is required by Title 63 O.S. 1-1950.4 of state law and by the Oklahoma State Board of Health Rules OAC 310-2-15-3. This uniform application shall be used as the only application for

More information

Older Adults Protective Service Act Protective Services Office February 2018

Older Adults Protective Service Act Protective Services Office February 2018 Older Adults Protective Service Act Protective Services Office February 2018 ACRONYMS OAPSA Older Adults Protective Services Act PDA Pa Department of Aging AAA Area Agency on Aging DOH Department of Health

More information

1500 Lizzie Street San Luis Obispo, CA (805) CHRISTIN L. NEWLON, DIRECTOR OF PERSONNEL

1500 Lizzie Street San Luis Obispo, CA (805) CHRISTIN L. NEWLON, DIRECTOR OF PERSONNEL 1500 Lizzie Street San Luis Obispo, CA 93401-3062 (805) 549-1230 CHRISTIN L. NEWLON, DIRECTOR OF PERSONNEL cnewlon@slcusd.org September 2014 Dear Volunteer, Thank you for your willingness to help the students

More information

Basic Nurse Assistant Program Spring 2018

Basic Nurse Assistant Program Spring 2018 Basic Nurse Assistant Program Spring 2018 The CNA program has very strict attendance policies. Please note: ALL CLASS AND LAB TIMES ARE REQUIRED BY THE ILLINOIS DEPARTMENT OF PUBLIC HEALTH. Attendance

More information

VOLUNTEER FIREFIGHTER APPLICATION

VOLUNTEER FIREFIGHTER APPLICATION GEORGIA FIREFIGHTER STANDARDS AND TRAINING COUNCIL VOLUNTEER FIREFIGHTER APPLICATION Candidate Name GFSTC ID# TO BE MAINTAINED LOCALLY BY FIRE DEPARTMENT/AGENCY AND AVAILABLE FORE REVIEW BY GFSTC STAFF

More information

VOLUNTEER POLICY & PROCEDURES

VOLUNTEER POLICY & PROCEDURES 3-9 VOLUNTEER POLICY & PROCEDURES MISSION OF SPECIAL OLYMPICS COLORADO The Mission of Special Olympics Colorado (SOCO) is to provide year-round sports training and athletic competition in a variety of

More information

Texas A&M AgriLife Extension Service Youth Protection Standards Rules and Guidelines Table of Contents

Texas A&M AgriLife Extension Service Youth Protection Standards Rules and Guidelines Table of Contents Texas A&M AgriLife Extension Service Youth Protection Standards Rules and Guidelines Table of Contents What s New/Important Reminders 3 Screening Overview 4 Who is screened through YPS? 4 Who is a direct

More information

Employee Registration Information

Employee Registration Information Employee Registration Information The licensee (employer) must submit the application on behalf of every employee hired to work as a private detective or armed security guard, even if the employee has

More information

ADMINISTRATIVE PROCEDURE CATEGORY: SUBJECT:

ADMINISTRATIVE PROCEDURE CATEGORY: SUBJECT: NO: 4595 PAGE: 1 OF 11 ADMINISTRATIVE PROCEDURE CATEGORY: SUBJECT: Partnerships in Education Program School Volunteer Programs A. PURPOSE AND SCOPE 1. To outline administrative procedures governing school

More information

APPLICATION FORM. 128 E. 8 th Street, 1338A Colegate Drive Cambridge, Oh Marietta, Ohio Name: Last First Middle.

APPLICATION FORM. 128 E. 8 th Street, 1338A Colegate Drive Cambridge, Oh Marietta, Ohio Name: Last First Middle. Chris Keylor, Superintendent Megan Atkinson, Treasurer Date of Application: APPLICATION FORM 1. Please complete this application and return to Ohio Valley ESC: Cambridge Office Marietta Office 128 E. 8

More information

Name: (Last, First, Middle Initial) Home Street Address: City: State: Address: Date of Birth: In Case of Emergency Notify: Name:

Name: (Last, First, Middle Initial) Home Street Address: City: State:  Address: Date of Birth: In Case of Emergency Notify: Name: 2017-2018 PARENT/COMMUNITY MEMBER VOLUNTEER APPLICATION GETTING STARTED In order to be cleared to volunteer with Richland County School District One, you will need to follow the steps below: 1. Richland

More information

STATE CERTIFICATION APPLICATION

STATE CERTIFICATION APPLICATION GEORGIA FIREFIGHTER STANDARDS AND TRAINING COUNCIL STATE CERTIFICATION APPLICATION Candidate Name GFSTC ID# TO BE MAINTAINED LOCALLY BY FIRE DEPARTMENT/AGENCY AND AVAILABLE FORE REVIEW BY GFSTC STAFF O.C.G.A.

More information

NURSING HOME ADMINISTRATOR REQUIREMENTS AND INSTRUCTIONS

NURSING HOME ADMINISTRATOR REQUIREMENTS AND INSTRUCTIONS South Carolina Department of Labor, Licensing and Regulation South Carolina Board of Long Term Health Care Administrators 110 Centerview Dr. Columbia SC 29210 P.O. Box 11329 Columbia SC 29211-1329 Phone:

More information

Pennsylvania State Board of Barber Examiners

Pennsylvania State Board of Barber Examiners This application is for Applicants that have an existing license that has been expired for five (5) years or more. Pennsylvania State Board of Barber Examiners REINSTATEMENT APPLICATION FOR PROFESSIONAL

More information

Consolidated Plan and Action Plan Substantial Amendments

Consolidated Plan and Action Plan Substantial Amendments Consolidated Plan and Action Plan Substantial Amendments FY 2013-14 through FY 2017-18 Table of Contents Substantial Amendment(s)* Tab 1. Substantial Amendment No. 1 FY 2013-14 Action Plan 1 2. Substantial

More information

AMHERST COUNTY SHERIFF'S OFFICE An equal opportunity employer Women and Minorities are encouraged to apply.

AMHERST COUNTY SHERIFF'S OFFICE An equal opportunity employer Women and Minorities are encouraged to apply. An equal opportunity employer Women and Minorities are encouraged to apply. Sheriff E.W. Viar Jr. P.O. BOX 410, 115 TAYLOR STREET, AMHERST, VIRGINIA 24521 BUSINESS 434.946.9381 ~ ADMINISTRATION 434.946.9301

More information

Employee Statement and Security Guard Application FEE $36

Employee Statement and Security Guard Application FEE $36 FOR OFFICE USE ONLY CASH#: UID: PREV. UID: CLASS: CODE: New York State Department of State Division of Licensing Services P.O. Box 22052 Albany, NY 12201-2052 Customer Service: (518) 474-7569 www.dos.ny.gov

More information

Cal North Live Scan FAQ

Cal North Live Scan FAQ LIST OF FAQs Why are background checks being required by Cal North?... 2 Background of Live Scan... 2 What is Live Scan Fingerprinting?... 2 What are the benefits of Live Scan?... 2 How Does the Process

More information

NDA C Purpose. NDA C Objective of rules. NDA C Definitions.

NDA C Purpose. NDA C Objective of rules. NDA C Definitions. NDA C 7 5-03-07-01 75-03-07-01. Purpose. Repealed effective January 1, 2011. NDA C 7 5-03-07-02 75-03-07-02. Objective of rules. Repealed effective January 1, 2011. NDA C 7 5-03-07-03 75-03-07-03. Definitions.

More information

COMMISSIONED SECURITY OFFICER APPLICATION

COMMISSIONED SECURITY OFFICER APPLICATION COMMISSIONED SECURITY OFFICER APPLICATION FOR OFFICE USE ONLY EFFECTIVE 12-2016 EXPIRES PROCESSED BY NOTICE: Information contained on this application is considered a public record and may be released

More information

Human Resources. Dear Teacher Applicant:

Human Resources. Dear Teacher Applicant: Human Resources Dear Teacher Applicant: Thank you for expressing interest in working as a teacher in the Diocese of San Jose. In order to be considered for employment, please complete and submit the following

More information

Police may conduct these checks. The following is a summary of various methods used for background checks and the requirements for each.

Police may conduct these checks. The following is a summary of various methods used for background checks and the requirements for each. Criminal Background Check and Security Check Policy for Nursing Facility Management in Louisiana Introduction All of our facilities are committed to the health, safety, and welfare of our residents. Part

More information

Information in State statutes and regulations relevant to the National Background Check Program: Washington

Information in State statutes and regulations relevant to the National Background Check Program: Washington Information in State statutes and regulations relevant to the National Background Check Program: Washington This document describes what was included as of February 2011 in Washington statutes and regulations

More information

Basic Nurse Assistant Program Fall 2017

Basic Nurse Assistant Program Fall 2017 Basic Nurse Assistant Program Fall 2017 Registration Requirements: 1. New Students New LLCC students may be required to attend a New Student Orientation session prior to registration. You may contact Registration

More information

FIREARMS TRAINING COURSE REQUIREMENTS TO OBTAIN A FIREARMS QUALIFICATION CARD

FIREARMS TRAINING COURSE REQUIREMENTS TO OBTAIN A FIREARMS QUALIFICATION CARD FIREARMS TRAINING COURSE REQUIREMENTS TO OBTAIN A FIREARMS QUALIFICATION CARD The California Private Security Industry is governed by laws enacted by the California Legislature and contained in the California

More information

REGISTERED OFFENDERS IN HEALTH CARE FACILITIES

REGISTERED OFFENDERS IN HEALTH CARE FACILITIES REGISTERED OFFENDERS IN HEALTH CARE FACILITIES The 2005 Legislature enacted a number of provisions related to the admission of registered offenders to health care facilities. These provisions went into

More information

PROPOSED REGULATION OF THE PEACE OFFICERS STANDARDS AND TRAINING COMMISSION. LCB File No. R September 7, 2007

PROPOSED REGULATION OF THE PEACE OFFICERS STANDARDS AND TRAINING COMMISSION. LCB File No. R September 7, 2007 PROPOSED REGULATION OF THE PEACE OFFICERS STANDARDS AND TRAINING COMMISSION LCB File No. R003-07 September 7, 2007 EXPLANATION Matter in italics is new; matter in brackets [omitted material] is material

More information

Originator: Issue No: Date: Page: Reference:

Originator: Issue No: Date: Page: Reference: POWAY UNIFIED SCHOOL DISTRICT ADMINISTRATIVE PROCEDURE ARTICLE: 4.0 PERSONNEL SUPPORT SERVICES 4.4 MANAGEMENT PERSONNEL Originator: Issue No: Date: Page: Reference: Superintendent 1 5/19/03 1 of 5 EC 35160.1,

More information

Substitute Application Instructions

Substitute Application Instructions Substitute Application Instructions Thank you for your interest in being a substitute teacher or nurse at Bay Head School. Once you have compiled all of the documents listed below, please bring them to

More information

AmeriCorps Application Packet

AmeriCorps Application Packet AmeriCorps Application Packet Dear Friend, Fill out the application to the best of your ability. Must be 18 years or older with a High School Diploma or GED to apply. Must be a U.S. Citizen or National

More information

UPGRADE- PRIVATE SECURITY OFFICER (PSO) TO COMMISSIONED SECURITY OFFICER (CSO) OR COMMISSIONED SCHOOL SECURITY OFFICER (CSSO)

UPGRADE- PRIVATE SECURITY OFFICER (PSO) TO COMMISSIONED SECURITY OFFICER (CSO) OR COMMISSIONED SCHOOL SECURITY OFFICER (CSSO) UPGRADE- PRIVATE SECURITY OFFICER (PSO) TO COMMISSIONED SECURITY OFFICER (CSO) OR COMMISSIONED SCHOOL SECURITY OFFICER (CSSO) FOR OFFICE USE ONLY EFFECTIVE 12-2016 EXPIRES PROCESSED BY NOTICE: Information

More information

Private Investigator and/or Security Guard Qualifying Agent Application

Private Investigator and/or Security Guard Qualifying Agent Application Vermont Secretary of State Office of Professional Regulation 89 Main Street, 3 rd Floor Montpelier VT 05620-3402 Kara Shangraw Licensing Board Specialist (802) 828-1134 kara.shangraw@sec.state.vt.us www.vtprofessionals.org

More information

DOUGLAS COUNTY SCHOOL DISTRICT Keith Lewis, Director of Human Resources 1638 Mono Avenue Minden, Nevada

DOUGLAS COUNTY SCHOOL DISTRICT Keith Lewis, Director of Human Resources 1638 Mono Avenue Minden, Nevada DOUGLAS COUNTY SCHOOL DISTRICT Keith Lewis, Director of Human Resources 1638 Mono Avenue Minden, Nevada 89423 klewis@dcsd.k12.nv.us (775) 782-7177 Fax (775) 782-8351 Dear Volunteer, Volunteers play a vital

More information

Facilities and Centers Background Check and Fingerprint Instructions

Facilities and Centers Background Check and Fingerprint Instructions Facilities and Centers Background Check and Fingerprint Instructions IF YOU HAVE QUESTIONS ABOUT YOUR BACKGROUND CHECK, CONTACT: Background Check Unit Phone: (505) 827-7326 Fax: (505) 827-7422 Email: cyfd.bcu@state.nm.us

More information

SECTION A PERSONAL INFORMATION

SECTION A PERSONAL INFORMATION Emergency Medical Services Provider Certification Application (Please print legibly) SECTION A PERSONAL INFORMATION Last Name First Name Middle Initial Suffix (Jr, Sr, II, III) Mailing Address City State

More information

Instructions and Resource Page for Application for a License to Operate a Child Care Facility

Instructions and Resource Page for Application for a License to Operate a Child Care Facility Instructions and Resource Page for Application for a License to Operate a Child Care Facility Instructions: All information on this application must be truthful and correct. Complete this application in

More information

Bridging the Gap between our Community and Schools

Bridging the Gap between our Community and Schools San Bernardino City Unified School District Family Resource Center 1525 W. Highland Avenue San Bernardino, CA 92411 (909) 880-4057 Office (909) 880-6587 Fax Bridging the Gap between our Community and Schools

More information

Basic Nurse Assistant Program Fall 2016 If you are interested in becoming a CNA, this information will be helpful.

Basic Nurse Assistant Program Fall 2016 If you are interested in becoming a CNA, this information will be helpful. Basic Nurse Assistant Program Fall 2016 If you are interested in becoming a CNA, this information will be helpful. The CNA program has very strict attendance policies. Please note: ALL CLASS AND LAB TIME

More information

Nurse Aide Training Program

Nurse Aide Training Program Nurse Aide Training Program In this Nurse Aide Training Program students will learn about and experience caring for another human being, including bathing, showering, oral and denture care, feeding a person

More information

EMPLOYMENT PROCEDURES FOR SUBSTITUTE TEACHING STAFF

EMPLOYMENT PROCEDURES FOR SUBSTITUTE TEACHING STAFF EMPLOYMENT PROCEDURES FOR SUBSTITUTE TEACHING STAFF PHASE I 1. Secure application form in person, mail, telephone, or website (www.pittsville.k12.wi.us). 2. Return the completed application form with a

More information

ADMISSION POLICY FOR ASSOCIATE DEGREE NURSING PROGRAM APPLICANTS

ADMISSION POLICY FOR ASSOCIATE DEGREE NURSING PROGRAM APPLICANTS ADMISSION POLICY FOR ASSOCIATE DEGREE NURSING PROGRAM APPLICANTS Responsible Administrative Officer: Associate Degree Nursing Program Director Date Issued: November 6, 2012 Date Last Review/Revised: January

More information

MERCER COUNTY SHERIFF S OFFICE CITIZEN S ACADEMY APPLICATION

MERCER COUNTY SHERIFF S OFFICE CITIZEN S ACADEMY APPLICATION MERCER COUNTY SHERIFF S OFFICE CITIZEN S ACADEMY APPLICATION Mercer County Sheriff's Office 4835 State Route 29 Celina, OH 45822 8216 Telephone: 419-586-7724 Fax: 419-586-2234 JEFF GREY SHERIFF JODIE LANGE

More information

DURANGO SCHOOL DISTRICT 9-R Application for AUTHORIZED VOLUNTEER status

DURANGO SCHOOL DISTRICT 9-R Application for AUTHORIZED VOLUNTEER status DURANGO SCHOOL DISTRICT 9-R Application for AUTHORIZED VOLUNTEER status Volunteers shall be required to make written application for specified voluntary services and the appropriate school principal or

More information

Admission Requirements

Admission Requirements Admission Requirements All Applicants: ATI TEAS V entrance exam is required for ALL applicants in addition the requirements listed below. Applicants must have at least a 60% Adjusted Individual Total Score

More information

Information in State statutes and regulations relevant to the National Background Check Program: Virginia

Information in State statutes and regulations relevant to the National Background Check Program: Virginia Information in State statutes and regulations relevant to the National Background Check Program: Virginia This document describes what was included as of February 2011 in Virginia statutes and regulations

More information

Associate of Applied Science in Registered Nursing Information and Application Packet

Associate of Applied Science in Registered Nursing Information and Application Packet Associate of Applied Science in Registered Nursing Information and Application Packet UACCB offers 3 registered nurse educational options including: Generic entry track that is available for the non-nurse

More information

Address: Street City State Zip

Address: Street City State Zip LUNENBURG COUNTY PUBLIC SCHOOLS P.O. Box 710 Kenbridge, VA 23944 APPLICATION FOR PROFESSIONAL EMPLOYMENT PERSONAL INFORMATION Date of Application: Date of Availability: Name: Last First Middle Social Sec.

More information

INSTRUCTIONS FOR COMPLETION OF ADVANCED PRACTICE APPLICATION

INSTRUCTIONS FOR COMPLETION OF ADVANCED PRACTICE APPLICATION KANSAS STATE BOARD OF NURSING Landon State Office Building 900 SW Jackson, Ste 1051 Topeka, KS 66612-1230 (785) 296-4929 INSTRUCTIONS FOR COMPLETION OF ADVANCED PRACTICE APPLICATION Licensure in Kansas

More information

UPGRADE- PRIVATE SECURITY OFFICER (PSO) TO COMMISSIONED SECURITY OFFICER (CSO) OR COMMISSIONED SCHOOL SECURITY OFFICER (CSS0)

UPGRADE- PRIVATE SECURITY OFFICER (PSO) TO COMMISSIONED SECURITY OFFICER (CSO) OR COMMISSIONED SCHOOL SECURITY OFFICER (CSS0) UPGRADE- PRIVATE SECURITY OFFICER (PSO) TO COMMISSIONED SECURITY OFFICER (CSO) OR COMMISSIONED SCHOOL SECURITY OFFICER (CSS0) FOR OFFICE USE ONLY EFFECTIVE 8-2015 EXPIRES PROCESSED BY NOTICE: Information

More information

Impact of Criminal Convictions on Registration of Medication Aides and Licensure of Massage Therapist in Virginia

Impact of Criminal Convictions on Registration of Medication Aides and Licensure of Massage Therapist in Virginia Impact of Criminal Convictions on Registration of Medication Aides and Licensure of Massage Therapist in Virginia INTRODUCTION Certain criminal convictions may prevent registration of medication aides

More information

Level 2 Background Screening Services

Level 2 Background Screening Services Level 2 Background Screening Services LIVE SCAN VALIDATION FORM OFFICE USE:>>>>Submitted date: Photo Upload Date: FORM B Updated 11/8/2016 FDLE Required Information.. Complete ALL Items if Not Applicable

More information

Yamhill County Sheriff s Office Concealed Handgun License Frequently Asked Questions

Yamhill County Sheriff s Office Concealed Handgun License Frequently Asked Questions Yamhill County Sheriff s Office Concealed Handgun License Frequently Asked Questions Q: What are the requirements for obtaining a concealed handgun license (CHL) in the State of Oregon? A. You must apply

More information

Internship Application Student Teacher Acceptance

Internship Application  Student Teacher Acceptance Orange County Public Schools agrees to accept the following intern for : Internship Application Student Teacher Acceptance Internship Type: Junior Senior Field Experience: ( Field Experience hours for

More information

NIMS Credentialing Criteria for CERTs

NIMS Credentialing Criteria for CERTs NIMS Credentialing Criteria for CERTs The following criteria are effective as of August 17, 2015. Criteria will be reviewed regularly and revised as needed. To receive a PIV-I (Personal Identity Verification-Interoperable)

More information

GEORGIA PEACE OFFICER STANDARDS AND TRAINING COUNCIL

GEORGIA PEACE OFFICER STANDARDS AND TRAINING COUNCIL GEORGIA PEACE OFFICER STANDARDS AND TRAINING COUNCIL APPLICATION FOR PRE-SERVICE TRAINING Return to: GEORGIA PEACE OFFICER STANDARDS AND TRAINING COUNCIL P.O. Box 349 Clarkdale, Georgia 30111 FOREWORD

More information

Bartow Medical and Fire Academy DS / EKG Course Syllabus

Bartow Medical and Fire Academy DS / EKG Course Syllabus Bartow Medical and Fire Academy DS / EKG Course Syllabus Rev. 05/05/2014 1 NAME: FOR PROGRAM OFFICE USE ONLY 1. STUDENT INFORMATION 2. FREE FROM ADDICTION, MENTAL, OR PHYSICAL DISEASE OR DEFECT ABILITY

More information

How to Apply. Volunteer Services. Becoming a volunteer. Requirements. Training. Uniform. Apply today!

How to Apply. Volunteer Services. Becoming a volunteer. Requirements. Training. Uniform. Apply today! Volunteer Services How to Apply Becoming a volunteer We invite you to join our team! To pursue a volunteer position at Providence, here are the steps you need to take: 1. Fill out the application and return

More information

PERSONNEL SERVICES Form 4120 APPLICATION FOR A CERTIFICATED POSITION

PERSONNEL SERVICES Form 4120 APPLICATION FOR A CERTIFICATED POSITION PERSONNEL SERVICES Form 4120 Employment Employment Application - Certificated Staff APPLICATION FOR A CERTIFICATED POSITION The School District considers applicants for all positions without regard to

More information

Department of Defense INSTRUCTION

Department of Defense INSTRUCTION Department of Defense INSTRUCTION NUMBER 5505.11 July 21, 2014 Incorporating Change 2, March 30, 2017 SUBJECT: Fingerprint Card and Final Disposition Report Submission Requirements References: See Enclosure

More information

DCW Agreement (Page 1 of 3)

DCW Agreement (Page 1 of 3) DCW Agreement (Page 1 of 3) Vendor Fiscal/Employer Agent (VF/EA) Financial Management Services (FMS) DIRECT CARE WORKER (DCW) AGREEMENT Name of Participant: Name of DCW: Participant ID: DCW ID: Address:

More information

County of San Luis Obispo Emergency Medical Services Agency

County of San Luis Obispo Emergency Medical Services Agency County of San Luis Obispo Emergency Medical Services Agency 2180 Johnson Ave, 2 nd Floor, San Luis Obispo, CA 93401 Phone: 805.788.2511 Fax: 805.788.2517 www.sloesma.org Dear EMT Applicant: Initial certification

More information