VOLUNTEER APPLICATION
Cesar Chavez Academy Middle School
MAIN OFFICE
6782 GOLDSMITH ST.,     DETROIT,   MI,   48209
313-842-0006  313-842-0167(f)
manuel.rosales@leonagroup.com

NAME :  *  *
SOC. SEC. NO. :
ADDRESS :   *
 
  *   *   *
HOME PHONE :
 
*
CELL PHONE :
DRIVER'S LICENSE :
E-MAIL ADDRESS :   *
CONFIRM E-MAIL ADDRESS :   *
DATE OF BIRTH :  *
US CITIZEN :
      
GENDER :       *
EMERGENCY CONTACT :
Organization :
School or District Employee :     

Please check all schools that you wish to volunteer at. *

Please check volunteer activities that is of interest to you.







Please check volunteer levels that are of interest to you.


I AM AVAILABLE ON :  *


Monday
           


Tuesday
           


Wednesday
           


Thursday
           


Friday
           


VOLUNTEER ETHNICITY – PLEASE CHECK ONE :
*




PLEASE CHECK OTHER LANGUAGES WHICH YOU KNOW :















Volunteer Experience/Talents
   
Languages/Skills or Hobbies :

Have you ever been convicted, found guilty, entered a plea of nolo contender (no contest), entered into a
deferred prosecution or pre-trial intervention agreement, or had adjudication withheld in a criminal offense other than a minor traffic violation (DUI is not a minor traffic violation)?

¿Alguna vez ha sido condenado, declarado culpable, se declaró inocente (no contestó), entró en una difirió el enjuiciamiento o el acuerdo de intervención previa al juicio, o se le retuvo la adjudicación en un delito penal que no sea una infracción de tránsito menor (DUI no es una infracción de tránsito menor)?

Please Check One :  * 

Are there any current criminal charges now pending against you?

¿Hay algún cargo penal actual pendiente en su contra?

Please Check One :  * 

Have you ever been arrested for and/or convicted for DUI / DWI (driving under the influence and/or driving while intoxicated)?

¿Alguna vez ha sido arrestado y / o condenado por DUI / DWI (conducir bajo la influencia y / o manejar en estado de ebriedad)?

Please Check One :  * 

Have you ever been arrested for and/or convicted for any sexually related crime?

¿Alguna vez ha sido arrestado y / o condenado por algún delito relacionado con la sexualidad?

Please Check One :  * 

Are you currently registered on any sex offender registry, or been required to register as a sex offender?

¿Está actualmente registrado en un registro de delincuentes sexuales o se le ha requerido que se registre como delincuente sexual?

Please Check One :  * 

Have you ever been arrested for and/or convicted for using and/or selling illegal drugs (including marijuana)?

¿Alguna vez lo arrestaron y / o condenaron por usar y / o vender drogas ilegales (incluida la marihuana)?

Please Check One :  * 

Are you eighteen (18) years of age or older?

¿Tiene dieciocho (18) años de edad o más?

Please Check One :  * 

I do not have a criminal record.

No tengo un registro de antecedentes penales.

Please Check One :  * 
Please Check One :  * 
Please Check One :  * 

Address of Past 5 years :
Dates at this Address Address

Alias and/or married names:

List Three (3) References:
Reference Reference Name Email Address Phone Cell Phone
#1
#2
#3

By clicking the SUBMIT button of this form, I acknowledge that I have been provided with a copy of this volunteer form and notice.  My electronic signature (via clicking SUBMIT) constitutes an acknowledgment that a State of Michigan criminal history background check will be conducted.  I have read and understood the foregoing and my certification is true and correct to the best of my knowledge and belief. I have sworn and affirm that the information submitted in support of this application is mine.

 

Al haciendo clic al botón de SUBMIT a este formulario, reconozco que me ha proporcionado una copia de esta forma voluntario y previo aviso. Mi firma electronica (haciendo clic en SUBMIT) constituye un reconocimiento de que un Estado de Michigan historia criminal revisión de antecedentes se llevará a cabo. He leído y comprendido lo anterior y mi certificación es verdadera y correcta a mi mejor saber y entender. He jurar y afirmar que la información presentada en apoyo de esta solicitud es el mío.
      
Answer Confirmation.... X
   
Please review your answer and check that this is the correct answer that you wish to provide.
 
   

 
Thank you for offering your time, talents and skills to enhance the education of our students.

CCAM

6782 Goldsmith Street - Detroit - Michigan - 48209 - (313) 842-0006

http://www.chavezgoldsmith.com

Thank you for your time and commitment to the education of our students.