FYBL Background Screening Form
2018 2017 VOLUNTEER BACKGROUND SCREENING This form will be retained by the League President until the end of the calendar year APPLICANT INFORMATION Legal Name (First, Middle, Last, Suffix):
Date of Birth:
E-mail Address:
Social Security #:
Home Street Address:
City:
ZIP Code:
Cell Phone:
Driver’s License # and State:
Work Street Address:
City:
ZIP Code:
Work Phone:
Employer:
Position Applying For:
Division and Name of Team:
❏ Manager ❏ Assistant Coach ❏ Team Mom/Dad ❏ Dugout Parent ❏ Other ___________________________ CRIMINAL HISTORY AND VOLUNTEER PARTICIPATION Have you ever been convicted of or pled guilty to any crime(s) involving or against a minor? ❏ Yes ❏ No If yes, describe in full:
Have you ever been refused participation in or dismissed from any other youth program? ❏ Yes ❏ No If yes, describe in full:
PARENT INFORMATION REFERENCES Please list three references, at least one of which has knowledge of your participation as a volunteer in a youth program Reference #1 and Phone Number: Reference #2 and Phone Number: Reference #3 and Phone Number:
NOTICE REGARDING BACKGROUND INVESTIGATION PURSUANT TO CALIFORNIA LAW Frontier Youth Baseball League Inc. (FYBL) intends to obtain information about you for volunteer screening purposes from a consumer reporting agency. Thus, you can expect to be the subject of “investigative consumer reports”. With respect to any investigative consumer report from an investigative consumer reporting agency (“ICRA”), FYBL may investigate the information contained in your volunteer application and other background information about you, including but not limited to obtaining a criminal record report, verifying references and your social security number. The results of this report may be used as a factor in making volunteer appointments. The source of any investigative consumer report (as that term is defined under California law) will be First Advantage Background Services Corp., P.O. Box 105292, Atlanta, GA 30348, 1-800-8456004. Their Privacy Policy can be reviewed at http://www.fadv.com/privacy-policy/. FYBL agrees to provide you with a copy of an investigative consumer report when required to do so under California law. Under California Civil Code section 1786.22, you are entitled to find out from an ICRA what is in the ICRA’s file on you with proper identification. Contact First Advantage Background Services Corp., P.O. Box 105292, Atlanta, GA 30348, 1-800-845-6004 for information on reviewing your file. RELEASE OF LIABILITY As a condition of volunteering, I give permission for Frontier Youth Baseball League Inc. (FYBL) to conduct background check(s) on me now and as long as I continue to be active with the organization, which may include a review of sex offender registries (some of which contain name only searches which may result in a report being generated that may or may not be me), child abuse and criminal history records. I understand that, if appointed, my position is conditional upon the league receiving no inappropriate information on my background. I hereby release and agree to hold harmless from liability, FYBL, the officers, and directors thereof, or any other person or organization that may provide such information. I also understand that, regardless of any previous appointments in other leagues or organizations, FYBL 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 league policies or principles. NOTE: FYBL will not discriminate against any person on the basis of race, creed, color, national origin, marital status, sexual orientation or disability.
Applicant Signature: ______________________________ Applicant Name (Print): ______________________________ Date: ________________ A COPY OF VALD GOVERNMENT ISSUED PHOTO IDENTIFICATION MUST BE ATTACHED TO COMPLETE THIS APPLICATION FOR LEAGUE USE ONLY Background Check Completed By:
Date:
System Used:
Background Cleared:
❏ First Advantage ❏ NCSI ❏ Yes ❏ No
Date of Birth:
E-mail Address:
Social Security #:
Home Street Address:
City:
ZIP Code:
Cell Phone:
Driver’s License # and State:
Work Street Address:
City:
ZIP Code:
Work Phone:
Employer:
Position Applying For:
Division and Name of Team:
❏ Manager ❏ Assistant Coach ❏ Team Mom/Dad ❏ Dugout Parent ❏ Other ___________________________ CRIMINAL HISTORY AND VOLUNTEER PARTICIPATION Have you ever been convicted of or pled guilty to any crime(s) involving or against a minor? ❏ Yes ❏ No If yes, describe in full:
Have you ever been refused participation in or dismissed from any other youth program? ❏ Yes ❏ No If yes, describe in full:
PARENT INFORMATION REFERENCES Please list three references, at least one of which has knowledge of your participation as a volunteer in a youth program Reference #1 and Phone Number: Reference #2 and Phone Number: Reference #3 and Phone Number:
NOTICE REGARDING BACKGROUND INVESTIGATION PURSUANT TO CALIFORNIA LAW Frontier Youth Baseball League Inc. (FYBL) intends to obtain information about you for volunteer screening purposes from a consumer reporting agency. Thus, you can expect to be the subject of “investigative consumer reports”. With respect to any investigative consumer report from an investigative consumer reporting agency (“ICRA”), FYBL may investigate the information contained in your volunteer application and other background information about you, including but not limited to obtaining a criminal record report, verifying references and your social security number. The results of this report may be used as a factor in making volunteer appointments. The source of any investigative consumer report (as that term is defined under California law) will be First Advantage Background Services Corp., P.O. Box 105292, Atlanta, GA 30348, 1-800-8456004. Their Privacy Policy can be reviewed at http://www.fadv.com/privacy-policy/. FYBL agrees to provide you with a copy of an investigative consumer report when required to do so under California law. Under California Civil Code section 1786.22, you are entitled to find out from an ICRA what is in the ICRA’s file on you with proper identification. Contact First Advantage Background Services Corp., P.O. Box 105292, Atlanta, GA 30348, 1-800-845-6004 for information on reviewing your file. RELEASE OF LIABILITY As a condition of volunteering, I give permission for Frontier Youth Baseball League Inc. (FYBL) to conduct background check(s) on me now and as long as I continue to be active with the organization, which may include a review of sex offender registries (some of which contain name only searches which may result in a report being generated that may or may not be me), child abuse and criminal history records. I understand that, if appointed, my position is conditional upon the league receiving no inappropriate information on my background. I hereby release and agree to hold harmless from liability, FYBL, the officers, and directors thereof, or any other person or organization that may provide such information. I also understand that, regardless of any previous appointments in other leagues or organizations, FYBL 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 league policies or principles. NOTE: FYBL will not discriminate against any person on the basis of race, creed, color, national origin, marital status, sexual orientation or disability.
Applicant Signature: ______________________________ Applicant Name (Print): ______________________________ Date: ________________ A COPY OF VALD GOVERNMENT ISSUED PHOTO IDENTIFICATION MUST BE ATTACHED TO COMPLETE THIS APPLICATION FOR LEAGUE USE ONLY Background Check Completed By:
Date:
System Used:
Background Cleared:
❏ First Advantage ❏ NCSI ❏ Yes ❏ No
