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2. First Name
3. Last Name
5. Address
7. City
8. State
9. Zip Code
11. Phone Number
13. Email Address
15. I have been criminally convicted or have charges pending for:*

    1. Felony homicide
    2. Sexual assault of any kind
    3. Physically or sexually abusing a minor
    4. Exploiting a minor
    5. Threats of violence
    6. Sale or distribution of controlled substance
    7. None of the above
16. I have had a criminal felony conviction within the last 10 years*

    1. Yes
    2. No
18. I was incarcerated in federal or state prison in the last 5 years*

    1. Yes
    2. No
19. I am now on parole/probation to any court, penal institution, or govt. entity, including being under house arrest or subject to a tracking device*

    1. Yes
    2. No
21. I was criminally convicted of a misdemeanor in the last 7 years involving*

    1. A crime of moral turpitude
    2. Violent or aggravated conduct with persons or property
    3. None of the above
22. I was criminally convicted of a misdemeanor in the last 3 years involving*

    1. A crime of moral turpitude
    2. Violent or aggravated conduct with persons or property
    3. DUI, DWI or related offense
    4. None of the above
24. I have an outstanding arrest warrant from any jurisdiction*

    1. Yes
    2. No
25. I am now subject to a protective order for physical or sexual abuse*

    1. Yes
    2. No
27. Primary description of desired volunteer service*
29. What are you volunteering to be?

    1. Chairman
    2. General volunteer
30. Community event I am interested in*
    -- Select One --Daddy Daughter DanceEaster Egg HuntJuly 4th Celebration - ParadeJuly 4th Celebration - Red, White & BoomVeteran's Day ProgramKaysville GivesCourt Ordered Community ServiceEagle Scout or Other Boy Scout ServiceChurch GroupOther
32. Volunteer experience*
34. Volunteer Service Agreement

    1. Failure to comply with any part of this agreement may result in dismissal as a volunteer.

    Volunteer Acknowledgement and Agreement 1. I acknowledge that I am volunteering solely for personal purposes or benefit without promise or expectation of compensation, benefits, or future employment from Kaysville City beyond any specified reimbursement agreements. 2. I agree to familiarize myself with, and abide by, Kaysville City’s policies and procedures regarding conduct, confidentiality, safety and related policies and procedures. I understand that I may be subject to the same pre-employment screening and background checks as paid employees performing similar duties. 3. I agree to follow the supervision and direction of any personnel, employee, or other volunteer to whom I have been assigned to perform services. I also agree to participate in any training required by Kaysville City in order to perform volunteer services. 4. I understand and agree to follow the guidelines set forth for volunteers that are under the age of 16 years of age. Volunteers that are 14 or 15 years of age may not volunteer for more than 3 hours on a school day and may not volunteer later than 7:00PM from September 1st to June 1st each year and may not volunteer later than 9:00 PM from June 2nd to August 31st each year. Volunteers that are 16 years of age or older do not have any restricted hours. 5. If any duties include driving on City business, I acknowledge that I must possess a valid driver’s license and complete the Employee Vehicle Use Policy Agreement. 6. I acknowledge that the City provides limited accidental liability coverage to volunteers, but that no other City-sponsored medical, retirement, or insurance apply to my associate with Kaysville City as a volunteer. 7. I acknowledge that Kaysville City may end my volunteer services with the City at any time for any reason.
36. Electronic Signature Agreement

    By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date. I, the undersigned, do hereby verify, under penalty of perjury, that the information provided herewith is complete, truthful and accurate to the best of my knowledge and belief. I do hereby agree to allow the City to obtain a name/date of birth BCI background check for enforcement purposes. I understand and agree that the League Director has the discretion to choose who will manage/coach. I accept that the League Director has the discretion to suspend or expel a coach for improper conduct.

    1. I agree.
38. Electronic Signature
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40. 1. Receive an email copy of this form.
41. Email address

    This field is not part of the form submission.

42. Submit

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