- Section I: Instruction
IJOC - E - RSU 21 Volunteers
Name______________________________________________ Date of Birth________________________
Address_________________________________________________________________________________
Town_______________________________________________State_________________Zip____________
Home Phone__________________________________ Business Phone___________________________
Driver’s License Number and State_____________________________________
Email Address
Confidentiality and Ethics Statement
As a volunteer for RSU 21, I understand that I have an obligation to maintain the highest level of ethical conduct. I agree to preserve the confidentiality of any or all information regarding RSU 21 students, staff, and any other related party, and will refrain from engaging in activities that would prejudice my ability (or the ability of others) to carry out my volunteer duties ethically, including violation of criminal or civil laws.
Signature_______________________________________________ Today’s Date____________________
Criminal History
1. Have you ever been charged or investigated for sexual abuse or harassment?
Yes___
No ___
2. Have you ever been convicted of a crime or pleaded “no contest” to a crime (other than a minor traffic offense)?
Yes___
No ___
If you have answered “Yes” to either of the above questions, please explain on a separate sheet. Prior criminal history is not an automatic bar to volunteer service. All information will be treated confidentially.
I attest that the above statements are accurate and true to the best of my knowledge. By my signature, I authorize RSU 21 to check criminal and/or civil records.
Signature_______________________________________________Today’s Date_____________________
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Please check schools you are willing to volunteer for:
____Kennebunk Elementary School
____Sea Road School
____Mildred L. Day School
____Kennebunkport Consolidated School
____Middle School of the Kennebunks
____Kennebunk High School
____Athletics
____Other ___________________________________________
It is your responsibility to notify us when you are no longer available.
Amended: 1/9/12
- Section I