VOLUNTEER APPLICATION
|
|
- Emily Walton
- 7 years ago
- Views:
Transcription
1 CASA of Los Angeles Member National Court Appointed Special Advocate Association 201 Centre Plaza Drive Suite 1100 Monterey Park, California Phone Fax VOLUNTEER APPLICATION Court Appointed Special Advocate For Office Use: Application received: / / Orientation: / / Interview: / / CONTACT INFORMATION: Full Name: Date of Birth: Home Phone: Cell Phone: Emergency Contact: Relationship: Home Phone: EMPLOYMENT INFORMATION: Unemployed Retired Full Time Part Time Self-Employed Seeking Employment Name of Current Employer, or if Retired or Unemployed, Previous Employer: Hire Date: To: Occupation: Work Phone: May we contact you at work? yes no Describe work experience: 09/17/13 Page 1 of 4
2 Education: High School (check last year completed) College (check last year completed) Specify area of study/degree: Graduate (check last year completed) Specify area of study/degree: Are you currently attending school? yes no If yes, specify school: Area of study/degree objective: Are you bilingual? yes no If yes, specify language(s): Ethnicity: African American Asian/Pacific Islander Hispanic/Latino Multi-Racial White/Non-Latino Other (specify): Decline to State How did you become aware of the CASA Program? Special skills and/or recreational interests: Describe prior volunteer experience: Have your life experiences included working with people of races and social/economic circumstances different than your own? yes no If yes, please describe: Time availability: CASA of Los Angeles requires a two-year commitment. The time demands for CASA volunteers vary with the case assignment. We estimate volunteers devote an average of 5 hours per week to case activities. Some activities may be completed by telephone. Court appearances and other case activities will require you to be available during the regular workweek hours (i.e. contact with CASA supervisors, social workers, teachers, therapists, etc.). Court hearings are scheduled in advance and ample notice is given, barring any unforeseen circumstances. Do you have any particular time restrictions? yes no If yes, please explain: Training: Successful completion of all training is required for acceptance into the CASA program. Attendance at all training sessions is mandatory. Can you commit to the training with advance notice? yes no (Many employers allow and encourage employee volunteer service to the community.) Travel: CASA of Los Angeles serves children throughout Los Angeles County. Traveling is necessary as the duties of a Court Appointed Special Advocate include monthly, face-to-face contact with a child wherever the child is residing. Traveling may also be necessary for interviews or conferences with other parties related to the case or to conduct on-site assessments. Liability: All volunteers are required to maintain automobile liability coverage, which satisfies the requirements under California law. Note: CASA of Los Angeles requires annual verification of automobile insurance and valid California Driver s License. 09/17/13 Page 2 of 4
3 Security Clearance: Please read and complete the security clearance form and return attached to this application. All applicants accepted for training will be fingerprinted for a background check conducted by the Los Angeles Superior Court. Have you ever been: Arrested for a crime against a child? yes no Arrested for a violent felony? yes no Arrested for a sex crime? yes no Health Background: CASA volunteers deal with sensitive issues that may be emotionally demanding. For this reason, the following questions are asked with the understanding that all information is confidential. 1. Do you have any physical limitations? yes no If yes, please describe. 2. Do you take any medications? yes no 3. Have you ever participated in counseling or psychotherapy? yes no 4. Do you have personal experience with issues related to any of the following: a. Child abuse yes no b. Domestic violence yes no c. Substance abuse yes no 5. Have you ever been prescribed any medications for mental health issues? yes no Personal Statement: Please submit a typed response to the following questions and attach the sheet to this application. 1. Describe your childhood. 2. State any personal or professional experiences you have had concerning issues of physical, sexual and/or emotional abuse or neglect or abandonment of children. 3. State any personal or professional experiences you have had concerning issues of domestic violence and/or substance abuse. 4. Why would you like to become a CASA volunteer? 5. How do you hope to benefit from this experience? 6. Have you or anyone you know ever been involved in a dependency court proceeding involving a child in the foster care system? yes no If yes, please explain. References: Please list three non-relative references who have known you for at least 2 years and can describe your personal and/or professional capacity to work as a volunteer with CASA. At least one reference should be from employment or volunteer experiences. These references will be contacted and asked to complete a reference questionnaire. All references are confidential. 1. Name: Relationship: Phone: 2. Name: Relationship: Phone: 3. Name: Relationship: Phone: 09/17/13 Page 3 of 4
4 AGREEMENT (Please initial where indicated.) As a potential CASA volunteer, I understand that I must meet the following preliminary qualifications: 1. I am over 21 years of age. 2. I do not have any criminal convictions. 3. I own a personal vehicle and am willing to drive in my capacity as a CASA volunteer. 4. I am not a foster parent nor do I receive financial compensation from DCFS or any DCFS contractor. 5. Upon successful completion of the screening and volunteer training, I will be expected to serve approximately 20 hours a month for at least 24 months as a Court Appointed Special Advocate. 6. As an applicant to be a CASA volunteer, I agree to: a) Submit to an investigation of suitability as a CASA, including but not limited to, being fingerprinted, criminal background check (FBI and Department of Justice), and Department of Motor Vehicles records check and/or provide CASA with a copy of your current driver s license, DMV printout and auto insurance annually. b) Participate in on-going supervision and continuing education training classes, cooperating fully with staff and adhering to all agency-approved report-writing criteria. As an applicant of CASA of Los Angeles I understand and acknowledge that CASA of Los Angeles is not obligated in any way to accept me into the volunteer training program by submission of this application. I understand that CASA of Los Angeles retains the right to refuse any individual they feel would not act in a way that would serve the best interests of the child. CASA of Los Angeles is not required to state the reason for declining an applicant into the program if they so choose. I understand that any applicant found to have been convicted of or having current charges pending for a felony or misdemeanor involving a sex offense, child abuse, or child neglect must not be accepted as a CASA volunteer. Signature of Applicant: Date: Please review your application personal statement, and security clearance for completeness and return all ORIGINAL SIGNED forms to: CASA of Los Angeles Edmund D. Edelman Children's Court 201 Centre Plaza Drive, Suite 1100 Monterey Park, CA /17/13 Page 4 of 4
5 SUPERIOR COURT OF CALIFORNIA, COUNTY OF LOS ANGELES SECURITY CLEARANCE CASA PRINT NAME: (Last) (First) (M.I.) Other Names Used: (Last) (First) (M.I.) Driver's License No.: Expiration: DOB: CA I.D. No.: Expiration: SSN: Proper conduct by Court employees inspires public confidence and trust in the Court and conveys the values of impartiality, equality, and fairness that brings integrity to the Court's work. Court employees are expected to demonstrate, through both words and actions, the highest level of personal integrity and honesty in all professional and personal dealings. Employees are also to refrain from any perceived or actual impropriety including violating the law. The Court conducts criminal background checks on candidates to whom it makes offers of employment. Existence of a criminal record is not an automatic bar to employment. In evaluating an applicant's suitability for Court employment, the Court will consider such factors as the nature and recency of the offense(s), the number of offenses and any mitigating circumstances. Full and complete responses to the questions below are required and will be carefully evaluated and verified. Employees' fingerprints are sent to State and Federal agencies for a check of criminal record history. Any false statement or omission of a material fact will cause forfeiture of all rights to employment. ARREST AND CONVICTION INFORMATION Pursuant to California Labor Code section 432.7, the Court, as a criminal justice agency, may inquire about arrests including those that did not result in convictions. 1. Have you ever been convicted of an offense(s) in any criminal or military court or has a juvenile court petition(s) ever been filed against you and found true? Please mark the appropriate box below and, if "Yes", please explain in the chart below. Note: Exclude any offense(s) which resulted in the successful completion of a deferred entry of judgment program(s) (pre-trial diversion) or any offense(s) where court record has been sealed. Security Clearance (Revised April 2007) Page 1 of 3
6 2. Are you currently being charged, or have you ever been charged, for any violation(s) of law other than minor traffic violations - examples of a minor traffic violation include driving without a license or with a suspended license, speeding, failing to signal, etc.? Please note that "driving under the influence" and "reckless driving" are not minor violations. Please mark the appropriate box below and, if "Yes", please explain in the chart below. 3. Have you ever been arrested or detained by any law enforcement agency or military authority including any arrests while a juvenile? Please mark the appropriate box below and, if "Yes", please explain in the chart below. Note: Exclude any arrests which resulted in the successful completion of a deferred entry of judgment program(s) (pretrial diversion) or any arrests where the records have been sealed. If the response to Question 1,2 and/or 3 is "Yes", provide the information requested below (attach additional sheets if necessary using the same format). Date Offense & Location (City/State) Disposition 4. As an adult, has a warrant(s) ever been issued for your arrest? Please mark the appropriate box below and, if "Yes", please explain in the chart below. Include date(s), reason(s), and disposition of warrant(s). Note: Exclude warrants which resulted in the successful completion of a deferred entry of judgment program(s) (pre-trial diversion). Date Reason Disposition Security Clearance (Revised April 2007) Page 2 of 3
7 Separation from Employment under Unfavorable Circumstances 5. While on probation or on a similar type of on-the-job trial period, were you ever terminated, discharged, released, or did you resign? Mark the appropriate box below. 6. Have you ever been terminated from any employment, or did you resign while you were under investigation, or after being informed discipline would be taken, or under any other unfavorable circumstances? Mark the appropriate box below. If the response to Question 5 and/or 6 is "Yes", provide the requested information below (attach additional sheets if necessary using the same format). Date Employer Reason for Discharge/Resignation and/or Failure of Probation I certify that the above information is true and correct and that I have not misrepresented my qualifications and/or background. I understand and agree that any false statement or omission of a material fact will cause forfeiture of all rights to employment or participation as a contractor or volunteer with the Superior Court of California, County of Los Angeles. SIGNATURE: DATE: FOR HUMAN RESOURCES USE ONLY Comments: Received by: Date: Security Clearance (Revised April 2007) Page 3 of 3
8 Please review the following checklist to make sure your application is complete, so that your application can be processed immediately: Did you Address all Personal Statement questions thoroughly? Provide three references with s on page 3? Initial ALL statements on page 4? Sign and date page 4? And on the Superior Court Security Clearance, did you Include your social security number (SSN) on page 1? Include your Driver s License # and Expiration on page 1? Sign and date page 3? Please submit all ORIGINAL SIGNED forms either in person or by post to: CASA of Los Angeles Edmund D. Edelman Children s Court 201 Centre Plaza Drive, Suite 1100 Monterey Park, CA
TV/Radio: Agency: Newspaper: Family/Friend: Referred By:
WWW.CASA-SATX.ORG P: 210.225.7070 F: 210.225.7040 406 SAN PEDRO, SAN ANTONIO, TX 78212? Please prioritize using (1, 2, & 3) your preference in joining classes. How did you hear about CASA? CASA Website
More informationCERTIFIED TEACHER APPLICATION INSTRUCTIONS
School City of Whiting 1500 Center Street, Whiting, IN 46394 Phone: 219-659-0656 Fax: 219-473-4008 www.whiting.k12.in.us CERTIFIED TEACHER APPLICATION INSTRUCTIONS The completed employment application
More informationHUMBOLDT COUNTY EMPLOYMENT APPLICATION
Name Address HUMBOLDT COUNTY EMPLOYMENT APPLICATION An Equal Opportunity If you believe you require an accommodation during the selection process, please contact us to make appropriate arrangements. Date
More informationGLYNN COUNTY SHERIFF S OFFICE IS AN EQUAL OPPORTUNITY EMPLOYER
P.O. Box 793 100 Sulphur Springs Road Brunswick, GA 31520 Telephone: (912) 554-7600 * Fax: (912) 554-7681 Web Page Address: www.glynncountysheriff.org INSTRUCTIONS AND INFORMATION PLEASE READ CAREFULLY
More informationTHE CHILD ADVOCATES OFFICE/
THE CHILD ADVOCATES OFFICE/ CASA OF LOS ANGELES AGENCY REPORT CASA OF LOS ANGELES CASA of Los Angeles (CASA/LA) is a special volunteer program of the Superior Court. CASA stands for Court Appointed Special
More informationMontana Application for Class 6 Specialist License School Psychologist Endorsement
Montana Application for Class 6 Specialist License School Psychologist Endorsement Requirements for Montana Class 6 School Psychologist Specialist license 1. Verification of current credentials as a nationally
More informationEastern Region HR Great Circle 330 North Gore Webster Groves, MO 63119 Phone: (314)968-2060 Fax: (314)968-8308 Email: Rebecca.Brenner@greatcircle.
Please mail, email or fax your application to one or more of the following locations, according to which job(s) or location(s) you are interested in joining. Eastern Region HR 330 North Gore Webster Groves,
More informationAPPLICATION FOR EMPLOYMENT Please TYPE or print using BLACK or BLUE ink
Name: First Last 11878 Avenue of Industry San Diego, CA 92128 Telephone: (858) 675-4200 Fax: (858) 675-9241 APPLICATION FOR EMPLOYMENT Please TYPE or print using BLACK or BLUE ink Date Application Completed:
More informationSUBSTITUTE TEACHER APPLICATION
SUBSTITUTE TEACHER APPLICATION Your interest in High Point Christian School is appreciated. We invite you to fill out this application and return it to our school office. If an opening occurs for which
More informationMichael Gayoso, Jr. Office of the County Attorney TH
Michael Gayoso, Jr. Office of the County Attorney TH 11 Judicial District/Crawford County, Kansas DIVERSION PROGRAM -- DRIVING UNDER THE INFLUENCE Pursuant to K.S.A. 22-2906 et seq. the Crawford County
More informationBrazos County Precinct 3 Volunteer Fire Department P.O. Box 5453 Bryan, TX 77805 www.pct3vfd.com Fighting Fires and Saving Lives, Since 1977
Brazos County Precinct 3 Volunteer Fire Department P.O. Box 5453 Bryan, TX 77805 www.pct3vfd.com Fighting Fires and Saving Lives, Since 1977 Dear Applicant: Thank you for your interest in becoming a member
More informationVolunteer Intern/Clerk Applications. Academic Status. Undergrad Graduate Student Law Student (1L) (2L) (3L) (Circle One) Application Term
OFFICE OF THE STATE S ATTORNEY COOK COUNTY, ILLINOIS ANITA ALVAREZ 69 W. Washington, Suite 3200 STATE S ATTORNEY Chicago, Illinois 60602 Volunteer Intern/Clerk Applications Academic Status Undergrad Graduate
More informationVolunteer Driver Application Form
Road to Recovery Volunteer Driver Application Form Please Print Name: Street Address: City State Zip: Other Address Information/ Email: Home Phone: Work Phone: Date of Birth: Occupation: Emergency Contact
More informationFRUITA POLICE DEPARTMENT
FRUITA POLICE DEPARTMENT Personal History Form for Police Officer Applicants Personal Full Legal Last First Middle Name Sex Height Weight Hair Eyes Social Security Number Driver s License No. State Expiration
More informationOrion Community Unit School District 223
Orion Community Unit School District 223 ORION, ILLINOIS Application Date: Position Applying for: Name: Social Security # Email: U.S. Citizen? Are you legally eligible to work in the United States? Home
More informationEMPLOYMENT APPLICATION. Get Involved
EMPLOYMENT APPLICATION Get Involved To be completed by a potential employee. Please complete this application by typing or printing in ink. INCOMPLETE or UNSIGNED applications will not be considered. Email
More informationThe Los Angeles Child Guidance Clinic
The Los Angeles Child Guidance Clinic Today s Date: APPLICATION FOR EMPLOYMENT It is the policy of THE LOS ANGELES CHILD GUIDANCE CLINIC to provide equal employment opportunity to all qualified applicants
More informationPARAPROFESSIONAL APPLICATION DOOLY COUNTY SCHOOLS PHONE: (229) 268-4761 202 EAST COTTON STREET FAX: (229) 268-6148 VIENNA, GEORGIA 31092
PARAPROFESSIONAL APPLICATION DOOLY COUNTY SCHOOLS PHONE: (229) 268-4761 202 EAST COTTON STREET FAX: (229) 268-6148 VIENNA, GEORGIA 31092 NAME: LAST FIRST MIDDLE/MAIDEN ADDRESS: STREET CITY STATE ZIP CODE
More informationPROJECT 375 EMPLOYMENT APPLICATION
PROJECT 375 EMPLOYMENT APPLICATION Thank you for your interest in PROJECT 375. Our application process is built to ensure the very best experience for you the applicant. Please follow these instructions
More informationCounty of Santa Clara Office of the District Attorney
County of Santa Clara Office of the District Attorney TO: PROSPECTIVE NEW EMPLOYEES AND VOLUNTEERS OF THE OFFICE OF THE DISTRICT ATTORNEY SUBJECT: BACKGROUND AND RECORD CHECK Jeffrey F. Rosen District
More informationOFFICE OF THE DISTRICT ATTORNEY Third Judicial District Of Kansas Chadwick J. Taylor, District Attorney
OFFICE OF THE DISTRICT ATTORNEY Third Judicial District Of Kansas Chadwick J. Taylor, District Attorney Shawnee County Courthouse Fax: (785) 251-4909 200 SE 7th Street, Suite 214 Family Law Fax: (785)
More informationSIERRA COLLEGE PART TIME FACULTY APPLICATION 5000 ROCKLIN ROAD ROCKLIN CA 95677
SIERRA COLLEGE PART TIME FACULTY APPLICATION 5000 ROCKLIN ROAD ROCKLIN CA 95677 An Equal Employment Opportunity/Affirmative Action Employer This application will be used by a committee to select applicants
More informationEMPLOYMENT APPLICATION
301 Church Avenue, Knoxville TN 37915 APPLICANT INSTRUCTIONS: If you need assistance filling out this application form please contact KAT at (865) 215-7800. 1. Please read "APPLICANT NOTE" below. 2. Complete
More informationADULT VOLUNTEER FORM FOR OSD S 2016 SUMMER CAMP
ADULT VOLUNTEER FORM FOR OSD S 2016 SUMMER CAMP Note: Complete these forms and send ASAP. Background and Fingerprint forms will be sent to you. Allow at least 6-7 weeks before May 5 th. I would like to
More informationDANVILLE-PITTSYLVANIA COMMUNITY SERVICES 245 HAIRSTON STREET DANVILLE, VIRGINIA 24540 434-799-0456
APPLICATION FOR EMPLOYMENT DANVILLE-PITTSYLVANIA COMMUNITY SERVICES 245 HAIRSTON STREET DANVILLE, VIRGINIA 24540 434-799-0456 INSTRUCTIONS: PLEASE READ CAREFULLY BEFORE COMPLETING THIS APPLICATION 1. The
More information$20.00 APPLICATION FEE MUST BE ATTACHED (The Application will not be accepted without the fee)
Lyon County Attorney Amy L. Aranda Marc Goodman, County Attorney Meghan K. Morgan 1 st Assistant County Attorney Lyon County Courthouse Jonathon L. Noble 430 Commercial Street, Emporia, KS 66801 Laura
More informationINITIAL TEACHER APPLICATION
INITIAL TEACHER APPLICATION Your interest in Hope Christian Academy is appreciated. We invite you to fill out this initial application and return it to our office. If an opening occurs for which you may
More informationOREGON CONFERENCE OF SEVENTH-DAY ADVENTISTS EDUCATION EMPLOYMENT APPLICATION
OREGON CONFERENCE OF SEVENTH-DAY ADVENTISTS EDUCATION EMPLOYMENT APPLICATION The Oregon Conference of Seventh-day Adventists ("Conference") is an equal opportunity employer and does not discriminate against
More informationFiling Fee $117.00. Instructions for Sealing a Criminal Record
Filing Fee $117.00 Instructions for Sealing a Criminal Record Effective 1-1-2015 This packet is to be used to assist you in filing an application to seal your criminal record. * * * * * * * * * * * * *
More informationAPPLICATION FOR LICENSURE AS A PSYCHOLOGIST
APPLICATION FOR LICENSURE AS A PSYCHOLOGIST Application Fee: $40 (Nonrefundable) File #: SECTION I. PErSONAl DATA (Board use only) Last First Middle Initial Jr., Sr., I, II (Note: Formal identification
More informationLEAGUE CITY VOLUNTEER FIRE DEPARTMENT
LEAGUE CITY VOLUNTEER FIRE DEPARTMENT 555 W. Walker Phone 281-554-1465 Dear Applicant: Thank you for your interest in becoming a member of the League City Volunteer Fire Department. Our success as a community
More informationIowa Administrator certificate? Yes No. Doctorate
CLINTON COMMUNITY SCHOOLS APPLICATION FOR 1401 12 th Ave. N. MIDDLE SCHOOL PRINCIPAL Clinton, Iowa 52733-2956 (563)243-0463 FAX: (563)243-0493 www.clinton.k12.ia.us DATE OF APPLICATION: FULL NAME: Last
More informationFirst Middle Last. Number and Street City State Zip Code Home Telephone # Work Telephone #
EMPLOYMENT APPLICATION Fire Department City of Sterling, Colorado 421 N. 4 th St., P.O. Box 4000 Sterling, CO 80751-0400 Phone (970) 522-9700 FAX (970)521-0632 www.sterlingcolo.com An Equal Opportunity
More informationARKANSAS STATE POLICE SECURITY OR INVESTIGATION COMPANY APPLICATION
ARKANSAS STATE POLICE SECURITY OR INVESTIGATION COMPANY APPLICATION FOR OFFICE USE ONLY EFFECTIVE 8-2015 EXPIRES PROCESSED BY NOTICE: Information contained on this application is considered a public record
More informationSEALING OF RECORDS. Conviction / Acquittal / Dismissal CLARK COUNTY DISTRICT ATTORNEY S OFFICE. DAVID ROGER District Attorney
SEALING OF RECORDS Conviction / Acquittal / Dismissal CLARK COUNTY DISTRICT ATTORNEY S OFFICE DAVID ROGER District Attorney NOTICE: This Website contains instructions for using the Clark County District
More information303 Online Form Worksheet
All Law Enforcement, Tribal Law Enforcement, Jail, and Secure Juvenile Detention Officers employed by an agency must be reported to the Training & Standards Bureau. Below are the minimum qualifications
More informationADP TOTALSOURCE MODEL EMPLOYMENT APPLICATION
ADP TOTALSOURCE MODEL EMPLOYMENT APPLICATION INSTRUCTIONS: Please detach this instruction page prior to giving the application form to the applicant. Please note that we generally advise against making
More informationAPPLICATION FOR EMPLOYMENT
USE ONLY BLACK INK OR TYPEWRITER ON THIS FORM. INCOMPLETE APPLICATION MAY DISQUALIFY YOU FROM FURTHER CONSIDERATION. APPLICATION FOR EMPLOYMENT METROPOLITAN TRANSPORTATION AUTHORITY The MTA is an Equal
More informationY- AmeriCorps Application
Y- AmeriCorps Application PERSONAL PROFILE NAME: LAST FIRST MIDDLE Are you a United States citizen, national, or lawful permanent resident alien? Yes No If you are a lawful permanent resident alien and
More informationCRITERIA FOR RESIDENCY AT APARTMENTS RESIDENT SCREENING AND SELECTION PROCESS
OR CRITERIA FOR RESIDENCY AT APARTMENTS RESIDENT SCREENING AND SELECTION PROCESS I. OCCUPANCY POLICY 1. Occupancy is based on the number of bedrooms in a unit. A bedroom is defined as a space within a
More informationOFFICE OF THE DISTRICT ATTORNEY Third Judicial District Of Kansas Chadwick J. Taylor, District Attorney
OFFICE OF THE DISTRICT ATTORNEY Third Judicial District Of Kansas Chadwick J. Taylor, District Attorney Shawnee County Courthouse Fax: (785) 251-4909 200 SE 7th Street, Suite 214 Family Law Fax: (785)
More informationHow to Apply for the AmeriCorps Program
PLEASE PRINT USING BLUE OR BLACK INK Date: 5/4/ PERSONAL PROFILE ***All positions are for one year (September 1, to August 16, 2016). You must be able to complete the full year of service to receive educational
More informationPRETRIAL DUI DIVERSION INFORMATION SHEET
PRETRIAL DUI DIVERSION INFORMATION SHEET If you have been charged with Driving Under the Influence of Alcohol and/or Drugs or an alcohol related charge, you may be eligible for consideration for the City
More informationCITY OF SALINA MUNICIPAL COURT DIVERSION INFORMATION AND APPLICATION
CITY OF SALINA MUNICIPAL COURT DIVERSION INFORMATION AND APPLICATION A diversion is a written agreement between the City Prosecutor and the defendant. During the diversion period, the prosecutor agrees
More informationApplicants must submit a new application for consideration for a new position. PLEASE PRINT. Name: Last First Middle. Address: Street City State Zip
APPLICATION FOR EMPLOYMENT Applicants may request reasonable accommodation in the application/ interview process. Application date: / / Applicants must submit a new application for consideration for a
More informationAPPLICATION FOR EMPLOYMENT DOT APPLICATION FOR TRUCK DRIVERS
APPLICATION FOR EMPLOYMENT DOT APPLICATION FOR TRUCK DRIVERS Motor Carrier: Address: City: State: Zip: Information required on this form complies with U.S. Department of Transportation Regulations 49CFR
More informationChild Abduction Unit Request for Investigation Summary
JESUS RODRIGUEZ ASSISTANT DISTRICT ATTORNEY OFFICE OF THE DISTRICT ATTORNEY COUNTY OF SAN DIEGO BONNIE M. DUMANIS DISTRICT ATTORNEY Child Abduction Unit Request for Investigation Summary San Diego 330
More informationApplication Checklist
Application Checklist POSITION APPLIED FOR: Indian Preference shall not be claimed without proof. Submitted applications without copies of verification documents, unanswered questions, omitted dates, omitted
More informationThe Executive Committee of the Baptist Convention of the State of Georgia
The Executive Committee of the Baptist Convention of the State of Georgia Employment Application According to its Constitution, the purpose of the Baptist Convention of the State of Georgia is to be a
More informationChildren s Hospital Los Angeles Application for Volunteer Service (Adult 18+)
Children s Hospital Los Angeles Application for Volunteer Service (Adult 18+) PLEASE TYPE DATE First Name Middle Name or Initial Last Name Street Address City Zip Social Security Number Birthday (Month/
More informationLOS ANGELES COUNTY SHERIFF'S DEPARTMENT CIVILIAN VOLUNTEER APPLICATION -OFFICE USE ONLY
VOLUNTEER APPLICATION CHECK LIST NAME: ADDRESS: PHONE HOME: CDL: _EXP DATE: _ CELL: E-MAIL: DATE OF BIRTH: _/ / CITIZENSHIP: -OFFICE USE ONLY ACCEPTED/REJECTED: REASON: VOLUNTEER APPLICATION DATE: HIRE
More informationCLINICAL INTERNSHIP OPPORTUNITIES for Marriage and Family Therapist Trainees/Interns and Master in Social Work Interns Valley Trauma Center s 60 hour Certified training as an In Home Outreach Counselor,
More informationNEW MEXICO SCHOOL FOR THE DEAF 1060 Cerrillos Road Santa Fe, NM 87505 (505) 476-6300-V/TTY/VP (505)476-6315-Fax Website: www.nmsd.k12.nm.
NEW MEXICO SCHOOL FOR THE DEAF 1060 Cerrillos Road Santa Fe, NM 87505 (505) 476-6300-V/TTY/VP (505)476-6315-Fax Website: www.nmsd.k12.nm.us EMPLOYMENT APPLICATION Application : Last First Middle Initial:
More informationApplication Information Please read the following before completing your application
Application Information Please read the following before completing your application Employment Policy The City of Suwanee is an Equal Opportunity Employer and does not discriminate on the basis of race,
More informationINSTRUCTION TO APPLICANTS FOR LICENSURE AS A OCCUPATIONAL THERAPIST OR OCCUPATIONAL THERAPY ASSISTANT
INSTRUCTION TO APPLICANTS FOR LICENSURE AS A OCCUPATIONAL THERAPIST OR OCCUPATIONAL THERAPY ASSISTANT A. TEMPORARY LICENSE (90 DAYS)- Applicant must submit the following: Temporary licenses are valid for
More informationState of Utah Department of Commerce Division of Occupational and Professional Licensing
State of Utah Department of Commerce Division of Occupational and Professional Licensing Official Use Only Number: Date Approved/Denied: Approved/Denied By: Retired Volunteer Health Care Practitioner APPLICANT
More informationWalnut Creek Police Department 1666 N. Main St. Walnut Creek, CA 94596 Ph: (925) 943-5844 Fax: (925) 943-5811
It i Walnut Creek Police Department 1666 N. Main St. Walnut Creek, CA 94596 Ph: (925) 943-5844 Fax: (925) 943-5811 CHECKLIST FOR MASSAGE ESTABLISHMENT / TECHNICIAN PERMIT Print and complete this packet
More informationOVERVIEW OF THE MULTNOMAH COUNTY DISTRICT ATTORNEY'S OFFICE
OVERVIEW OF THE MULTNOMAH COUNTY DISTRICT ATTORNEY'S OFFICE INTRODUCTION This outline was prepared for Deputy District Attorney Applicants. It provides an overview of the internal workings of the Multnomah
More informationAPPLICANT INSTRUCTIONS / INFORMATION
APPLICANT INSTRUCTIONS / INFORMATION Please print legibly. Answer all questions completely. Incomplete or illegible applications will not be considered. Use the abbreviation N/A if a particular provision
More informationCITY OF COEUR D'ALENE
CITY OF COEUR D'ALENE HUMAN RESOURCES City Hall, 710 E. Mullan Avenue Cœur d Alene, Idaho 83816-3964 EXAM ANNOUNCEMENT FOR POLICE OFFICER Apply by August 15, 2014 for the September 8-12, 2014 Testing Process
More informationArticle 6. Background Check 87355 CRIMINAL RECORD CLEARANCE 87355
Regulations RESIDENTIAL CARE FACILITIES FOR THE ELDERLY 87355 (Cont.) Article 6. Background Check 87355 CRIMINAL RECORD CLEARANCE 87355 (a) (b) The Department shall conduct a criminal record review of
More informationTexas Board of Nursing 333 Guadalupe, Ste 3-460, Austin, TX 78701 Phone: 512-305-7400
For Office Use Only Date: Amount: Texas Board of Nursing 333 Guadalupe, Ste 3-460, Austin, TX 78701 Phone: 512-305-7400 PETITION FOR DECLARATORY ORDER Audit #: FBI HX: YES NO Complete this application
More informationPERSONAL INFORMATION - Please list full legal name as it appears on your Social Security card. Name: Last First Middle Initial
Updated 11/2015 Midstate Independent Living Consultants, Inc. 3262 Church Street, Stevens Point, WI 54481 715-344-4210 V/TTY 800-382-8484 V/TTY 715-344-4414 FAX -------------------------------------------------------------------------------------------------
More informationAPPLICATION FOR NON-EMPLOYEES
APPLICATION FOR NON-EMPLOYEES NorthEast Treatment Centers is an Equal Opportunity company and does not discriminate on the basis of race, color, religion, gender, age, ethnic or national origin, handicap,
More informationCERTIFIED TEACHER APPLICATION
Tucson International Academy Academia International de Tucson CERTIFIED TEACHER APPLICATION Tucson International Academy Human Resources Department 2700 W Broadway Blvd Tucson, AZ 85745 JOB OPENINGS Phone:
More informationNote: We do not buy out Law Enforcement Contracts.
Sheriff s Office Applicants Re: Application Process In order to speed your application process, only submit your application after you have obtained all of the following information: Complete an application
More informationSan Luis Coastal Unified School District 1500 Lizzie Street, San Luis Obispo, CA 93401 (805) 549-1235 WE ARE AN EQUAL OPPORTUNITY EMPLOYER
San Luis Coastal Unified School District 1500 Lizzie Street, San Luis Obispo, CA 93401 (805) 549-1235 WE ARE AN EQUAL OPPORTUNITY EMPLOYER \ Thank you for your interest in working as a BILINGUAL substitute
More informationHighland Beach Police Department
Highland Beach Police Department RESERVE POLICE OFFICER APPLICANT NAME: (Last), (First), (Middle) SUPPLEMENTAL QUESTIONS: Do you possess a valid driver s license? YES NO D/L Number: State: Have you had
More informationPrivate Protective Services - Contract Security Company Application, Page 1
Private Protective Services - Contract Security Company Application, Page 1 STATE OF TENNESSEE DEPARTMENT OF COMMERCE & INSURANCE DIVISION OF REGULATORY BOARDS PRIVATE PROTECTIVE SERVICES 500 JAMES ROBERTSON
More informationJOB OPPORTUNITY. Firefighter-Fire Department. P.O. Box 635030 Nacogdoches, TX 75963-5030 Office: 936-559-2567 Fax: 936-559-2915
JOB OPPORTUNITY Firefighter-Fire Department P.O. Box 635030 Nacogdoches, TX 75963-5030 Office: 936-559-2567 Fax: 936-559-2915 Firefighter-Nacogdoches Fire & Rescue Nacogdoches Firefighters provides exceptional
More informationThis is a Legal Document. By completing and signing, this you certify under
APPLICATION FOR WYOMING NURSING ASSISTANT CERTIFICATION (CNA) BY ENDORSEMENT, or DEEMING *All certificates expire December 31 of every EVEN year* This is a Legal Document. By completing and signing, this
More informationEmployment Application
Employment Application We appreciate the opportunity to review your qualifications for employment with the company. So that we can thoroughly consider your special skills and abilities, we would appreciate
More informationApplication for Employment
Application for Employment 1221 East Broad St Columbus, Ohio 43205 Phone 614.453.4830 Fax 614.453.4845 Application for Employment An Equal Employment Opportunity / Affirmative Action Employer Name: Last
More informationWinslow Indian Health Care Center, Inc. Employment Application 500 North Indiana Avenue, Winslow, Arizona 86047 Fax Number: (928) 289-8024
Winslow Indian Health Care Center, Inc. Employment Application 500 North Indiana Avenue, Winslow, Arizona 86047 Fax Number: (928) 289-8024 The Winslow Indian Health Care Center, Inc. is a tribal entity.
More informationOCCUPATIONAL THERAPY ASSISTANT or OCCUPATIONAL THERAPIST
STATE OF UTAH DIVISION OF OCCUPATIONAL AND PROFESSIONAL LICENSING APPLICATION FOR LICENSURE OCCUPATIONAL THERAPY ASSISTANT or OCCUPATIONAL THERAPIST APPLICATION INSTRUCTIONS AND INFORMATION General Statement:
More informationVermont Board of Nursing INSTRUCTION TO APPLICANTS FOR LICENSURE AS A REGISTERED NURSE. LICENSE BY ENDORSEMENT Applicant must submit the following:
Vermont Secretary of State 89 Main St., 3 rd Floor Montpelier VT 05620-3402 Nursing (802) 828-2396 www.vtprofessionals.org Vermont Board of Nursing INSTRUCTION TO APPLICANTS FOR LICENSURE AS A REGISTERED
More informationDRUG COURT DEFERRED JUDGMENT INFORMATION SHEET
DRUG COURT DEFERRED JUDGMENT INFORMATION SHEET If you have been charged with a crime involving possession of a controlled substance and/or possession of drug paraphernalia, you may be eligible to participate
More information3. I agree to observe all of the guidelines and policies for the employer where I am applying.
Application Employment Catholic School Certified Staff (School Administrators, Teachers, Substitute Teachers, Part-time Teacher, educational support personnel such as school counselor) Thank you for your
More informationAPPLICATION FOR ADDICTION COUNSELOR TRAINEE RECOGNITION OR ADDICTION COUNSELOR TRAINEE RENEWAL
Board of Addiction and Prevention Professionals (BAPP) 3101 West 41 st Street, Suite 205, Sioux Falls, SD 57105 Phone: 605-332-2645 Fax: 605-332-6778 Email: bapp@midconetwork.com Web: www.dss.sd.gov/bapp
More informationThis is a Legal Document. By completing and signing this, you certify under penalty of perjury
APPLICATION FOR WYOMING REGISTERED NURSE (RN) or LICENSED PRACTICAL NURSE (LPN) By EXAMINATION *All licenses expire December 31 of every EVEN year* This is a Legal Document. By completing and signing this,
More informationThank you again for your interest in volunteering. We look forward to your participation with SPORTS for Exceptional Athletes.
Welcome Volunteer, SPORTS for Exceptional Athletes would like to thank you for your interest in volunteering for our program. SPORTS for Exceptional Athletes (S4EA) is a community based sports program
More informationProject Transformation Oklahoma Application PERSONAL PROFILE
PERSONAL PROFILE 1. NAME: LAST FIRST MIDDLE 2. AmeriCorps members must be a United States citizen, U.S. National or Lawful Permanent Resident. Are you a U.S. Citizen, national, or lawful permanent resident
More informationEMPLOYMENT/CREDENTIALING APPLICATION
Beacon Specialized Living Services, Inc. EMPLOYMENT/CREDENTIALING APPLICATION We do not discriminate on the basis of race, color, religion, national origin, sex, age or disability. It is our intention
More information(Updated: 10/12/2015)
DRUG TESTING & BACKGROUND CHECK Pfizer s Drug Testing and Background Check Requirements for Contingent Workers and Suppliers, Including Criminal and MVR Record Checks, FDA Debarment Database and DEA Controlled
More informationCOMMUNITY COUNSELING CENTER Application For Employment
2801 C Court, Ashtabula, OH 44004 PHONE: (440) 998-4210 FAX: (440) 998-6489 COMMUNITY COUNSELING CENTER Application For Employment WEBSITE: www.cccohio.com We consider applicants for all positions without
More informationARKANSAS STATE POLICE ALARM SYSTEMS COMPANY RENEWAL APPLICATION
ARKANSAS STATE POLICE ALARM SYSTEMS COMPANY RENEWAL APPLICATION FOR OFFICE USE ONLY EFFECTIVE 8-2015 EXPIRES PROCESSED BY NOTICE: Information contained on this application is considered a public record
More informationVermont Board of Nursing INSTRUCTION TO APPLICANTS FOR LICENSURE AS A LICENSED NURSING ASSISTANT
Vermont Secretary of State 89 Main St., 3 rd Floor Montpelier VT 05620-3402 Nursing (802) 828-3089 www.vtprofessionals.org Vermont Board of Nursing INSTRUCTION TO APPLICANTS FOR LICENSURE AS A LICENSED
More informationSUPERIOR COURT OF CALIFORNIA COUNTY OF SUTTER
SUPERIOR COURT OF CALIFORNIA COUNTY OF SUTTER M. B. Todd Court Executive Officer 463 Second Street, Yuba City, CA 95991 Civil Division CHILD CUSTODY INVESTIGATION QUESTIONNAIRE This questionnaire will
More informationHow To Get Your Criminal History From The Justice Department
Criminal Records & Employment 1. What exactly is a criminal record? YOUR LEGAL RIGHTS A criminal record, formally known as a summary criminal history, or more commonly known as a rap sheet, is a list of
More informationGENERAL INFORMATION 2009 EDITION
Texas Foster Youth Justice Project www.texasfosteryouth.org Sealing Juvenile Court Records in Texas GENERAL INFORMATION 2009 EDITION Table of Contents TABLE OF CONTENTS 1 Introduction...........................................................
More informationFebruary 29, 2016. Dear Potential Volunteer,
February 29, 2016 Dear Potential Volunteer, Thank you for the interest you have expressed in Empower Yolo and our volunteer training program. Training is held on Tuesdays, Thursdays and Saturdays starting
More informationState of Utah Department of Commerce Division of Occupational and Professional Licensing
State of Utah Department of Commerce Official Use Only Number: Date Approved/Denied: Approved/Denied By: Temporary Physical Therapist Temporary Physical Therapist Assistant APPLICANT INFORMATION Full Legal
More informationFederal & State Criminal Background Check. Consent to Fingerprint Background Check
Federal & State Criminal Background Check Superior School District #3 (SSD3) requires that a national & state criminal history background check, including fingerprinting, be completed for all candidates
More informationCOUNTY OF LOS ANGELES PROBATION DEPARTMENT OPEN COMPETITIVE JOB OPPORTUNITY
COUNTY OF LOS ANGELES PROBATION DEPARTMENT OPEN COMPETITIVE JOB OPPORTUNITY Bulletin No. 964 Posting Date: January 18, 2011 JOB TITLE EXAM NUMBER DEPUTY PROBATION OFFICER I (RESIDENTIAL TREATMENT/DETENTION
More informationMemphis Police Department Police Officer Application Packet
Memphis Police Department Police Officer Application Packet MINIMUM REQUIREMENTS 54 Semester Hours at an Accredited College or University or Two years of continuous Military Service with an honorable discharge
More informationApplication Letter of Instruction
STATE OF NEVADA BOARD OF OCCUPATIONAL THERAPY P.O. BOX 34779 Reno, Nevada 89533-4779 (775) 746-4101 / Fax: (775) 746-4105 / Toll Free: (800) 431-2659 Email: board@nvot.org / Website: www.nvot.org TYPES
More information2014 PERSONAL HISTORY QUESTIONNAIRE
Department of Safety and Security 6054 South Drexel Avenue Chicago, Illinois 60637 2014 PERSONAL HISTORY QUESTIONNAIRE Applicant Name: Instructions Applicants for police officer positions at The University
More informationAddress: Street. If you are under 18 years of age, do you have a work permit? Yes If you have ever worked under another name, please identify:
APPLICATION FOR EMPLOYMENT Miles farmers market 28560 Miles Road, Solon, OH 44139 ph 440.248.5222 toll free 800.646.4537 fx 440.248.7518 www.milesfarmersmarket.com Thank you for your interest in applying
More informationAn Equal Opportunity Employer
An Equal Opportunity Employer Federal, State and Local Laws prohibit discrimination because of race, color, sex, age, national origin, ancestry, handicap or veteran status. APPLICATION FOR EMPLOYMENT (Please
More information3354:1-44-01.1 Pre-Employment Background Check and Drug Screening Procedure 1
3354:1-44-01.1 Pre-Employment Background Check and Drug Screening Procedure 1 (A) Introduction (1) The College provides this procedure to insure the fair and consistent utilization of background checks
More information