LCOC Volunteer Application

Name:
Date of Birth:
Social Security #
Address
City
State
Cell Phone:
E-mail Address:
Occupation
Employer:
Office Address:
Special professional training, skills, hobbies
Community affiliations (Clubs, Service Organizations, etc:
Previous volunteer experience (including the year):
Do you have children in the program? Yes No If yes, list full name and what level?
Special Certification (i.e. CPR, Medical, etc):
Do you have a valid driver’s license?
If Yes, Driver’s License# :
License State :
Have you ever been refused participation in any other youth programs?
If yes, explain:

In which of the following would you like to participate? (Check one or more.)

Commissioner
Coach
Field Maintenance
Manager
Scorekeeper
Concession Stand
Umpire
Other
List Other:

Please list three references, at least one of which has knowledge of your participation as a volunteer in a youth program:

Name Phone

As a condition of volunteering, I give permission for the Liberty City Optimist Club to conduct a background check on me, which may include a review of sex offender registries, child abuse and criminal history records. I understand that, if appointed, my position is conditional upon the organizations receiving no inappropriate information on my background. I hereby release and agree to hold harmless from liability the local Liberty City Optimist Club of Florida, Inc., the officers, employees and volunteers thereof, or any other person or organization that may provide such information. I also understand that, regardless of previous appointments, Liberty City Optimist is not obligated to appoint me to a volunteer position. If appointed, I understand that, prior to the expiration of my term; I am subject to suspension by the President and removal by the Board of Directors for violation of Liberty City Optimist Club policies or principles.

Applicant Name:
I Agree All Terms & Conditions