Volunteer Board Member Application
Gorham Football Boosters, Inc. Volunteer Board Member Application Applicant’s Information: Legal Name: _____________________________________ Home Phone: ________________________ Cell Phone: __________________ Address: ______________________________________ City: ___________________________________________ State: _______________ Zip: ____________________ Date of Birth: ______/______/______ Email address: __________________________________ Occupation: ________________________________ Position volunteering for: _____________________________________________ Do you have a child/children participating in any GFB program this year? □Yes □No If yes, which program(s)? □ Cubs Football □ Jr. Grizzlies Football □ Grizzlies □ Rams
Qualifications: Do you have experience working with youth programs or nonprofits? □Yes □No Please list any experience you have had working with youth organizations or other nonprofit groups, including dates, locations, and responsibilities: _________________________________________________________________________________ _________________________________________________________________________________ _________________________________________________________________________________ _________________________________________________________________________________ _________________________________________________________________________________ _________________________________________________________________________________
Please list any skills, background, job experiences you have which you feel the organization may benefit from: _________________________________________________________________________________ _________________________________________________________________________________ _________________________________________________________________________________ _________________________________________________________________________________ _________________________________________________________________________________ _________________________________________________________________________________
Page 1 of 3
Explain why you would make a good board member and what would distinguish you from other applicants: _________________________________________________________________________________ _________________________________________________________________________________ _________________________________________________________________________________ _________________________________________________________________________________ _________________________________________________________________________________ _________________________________________________________________________________
Background History: Have you ever been convicted of or plead guilty to any crime(s). □Yes □No Are there any criminal charges pending against you, especially involving or against a minor? □Yes □No Have you ever been convicted or are currently charged with child abuse, neglect and/or domestic violence?
□Yes □No
Have you ever been refused participation in any other youth programs? □Yes □No Has your driver’s license been revoked or suspended in the last 5 years? □Yes □No Have you been convicted of the use of or driving while under the influence of drugs/alcohol in the last 5 years? □Yes □No Have you been convicted of crimes involving money, funds, or fraud? □Yes □No Is there any other circumstance which would call into question you being entrusted with the funds or personal information of others? □Yes □No If you answered Yes to any of the above questions please explain in detail on the reverse side of this page. Please provide 3 character references, who are not relatives, which can vouch for your character while working with youths, program funds and sensitive information: Reference Name 1: ________________________________ Phone: ______________________ Reference Name 2: ___________________________________ Phone: ______________________ Reference Name 3: ___________________________________ Phone: ______________________
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I, _______________________________________________, understand that my relationship to Gorham Football Boosters, Inc., as a volunteer is an “at will” relationship and that I or Gorham Football Boosters, Inc. may terminate the relationship at anytime without cause as identified by its by-laws. My signature below constitutes authorization to check my employment history, including without limitation, my criminal arrest and conviction record, references, and release of investigatory information possessed by any state, local, or federal agency. I understand that I have a right to obtain a copy of my background check report. I understand that, regardless of previous appointments, GFB, Inc. is not obligated to appoint me to any board position now or in the future. I am subject to suspension and/or removal by the Board of Directors for violation of GFB, Inc. and/or Southern Maine Youth Football (SMYFL) By-Laws or Code of Conduct. I also understand that this application is only good for the term of appointment. I further authorize those persons, agencies, or entities to fully provide Gorham Football Boosters, Inc any information on the matter set forth above. I expressly waive in connection with any request for or provision of such information, any claims, including, without limitation, defamation, emotional distress, invasion of privacy, or interference with contractual relations that I otherwise might have against Gorham Football Boosters, Inc., its agents, and its officials, or against any provider of such information. The Gorham Football Boosters, Inc requires that everyone applying to volunteer for a board position with Gorham Football Boosters, Inc reads and signs this agreement, by-laws and code of conduct. Appointed board members need to be aware of the need for confidentiality in regard to any child-related information. My signature below authorizes Gorham Football Boosters, Inc. to conduct a criminal background check on me and to check my personal references. I give consent for this disclosure and agree to hold harmless from liability Gorham Football Boosters, Inc. and any other persons or organizations providing such information. I understand that the information submitted in this application may be reviewed by an interview team to include GFB Board members. I have read and understand the above statements and have truthfully completed this application.
Print Name: __________________________________________ Date: ___________________________ Signature: __________________________________________________________ Please attach a photocopy of your driver’s license to this application. Please return your completed application and all attachments to: Gorham Football Boosters, Inc. / P.O. Box 413, Gorham, ME. O4038 Or, Scan the completed form and email to [email protected] Board Approved: □ Yes □ No Date Approved: _________________ President’s Signature: __________________________________________ Revision History Change Description
First Publication
Page 3 of 3
11/15/2012
Revised By
Date Revised
Qualifications: Do you have experience working with youth programs or nonprofits? □Yes □No Please list any experience you have had working with youth organizations or other nonprofit groups, including dates, locations, and responsibilities: _________________________________________________________________________________ _________________________________________________________________________________ _________________________________________________________________________________ _________________________________________________________________________________ _________________________________________________________________________________ _________________________________________________________________________________
Please list any skills, background, job experiences you have which you feel the organization may benefit from: _________________________________________________________________________________ _________________________________________________________________________________ _________________________________________________________________________________ _________________________________________________________________________________ _________________________________________________________________________________ _________________________________________________________________________________
Page 1 of 3
Explain why you would make a good board member and what would distinguish you from other applicants: _________________________________________________________________________________ _________________________________________________________________________________ _________________________________________________________________________________ _________________________________________________________________________________ _________________________________________________________________________________ _________________________________________________________________________________
Background History: Have you ever been convicted of or plead guilty to any crime(s). □Yes □No Are there any criminal charges pending against you, especially involving or against a minor? □Yes □No Have you ever been convicted or are currently charged with child abuse, neglect and/or domestic violence?
□Yes □No
Have you ever been refused participation in any other youth programs? □Yes □No Has your driver’s license been revoked or suspended in the last 5 years? □Yes □No Have you been convicted of the use of or driving while under the influence of drugs/alcohol in the last 5 years? □Yes □No Have you been convicted of crimes involving money, funds, or fraud? □Yes □No Is there any other circumstance which would call into question you being entrusted with the funds or personal information of others? □Yes □No If you answered Yes to any of the above questions please explain in detail on the reverse side of this page. Please provide 3 character references, who are not relatives, which can vouch for your character while working with youths, program funds and sensitive information: Reference Name 1: ________________________________ Phone: ______________________ Reference Name 2: ___________________________________ Phone: ______________________ Reference Name 3: ___________________________________ Phone: ______________________
Page 2 of 3
I, _______________________________________________, understand that my relationship to Gorham Football Boosters, Inc., as a volunteer is an “at will” relationship and that I or Gorham Football Boosters, Inc. may terminate the relationship at anytime without cause as identified by its by-laws. My signature below constitutes authorization to check my employment history, including without limitation, my criminal arrest and conviction record, references, and release of investigatory information possessed by any state, local, or federal agency. I understand that I have a right to obtain a copy of my background check report. I understand that, regardless of previous appointments, GFB, Inc. is not obligated to appoint me to any board position now or in the future. I am subject to suspension and/or removal by the Board of Directors for violation of GFB, Inc. and/or Southern Maine Youth Football (SMYFL) By-Laws or Code of Conduct. I also understand that this application is only good for the term of appointment. I further authorize those persons, agencies, or entities to fully provide Gorham Football Boosters, Inc any information on the matter set forth above. I expressly waive in connection with any request for or provision of such information, any claims, including, without limitation, defamation, emotional distress, invasion of privacy, or interference with contractual relations that I otherwise might have against Gorham Football Boosters, Inc., its agents, and its officials, or against any provider of such information. The Gorham Football Boosters, Inc requires that everyone applying to volunteer for a board position with Gorham Football Boosters, Inc reads and signs this agreement, by-laws and code of conduct. Appointed board members need to be aware of the need for confidentiality in regard to any child-related information. My signature below authorizes Gorham Football Boosters, Inc. to conduct a criminal background check on me and to check my personal references. I give consent for this disclosure and agree to hold harmless from liability Gorham Football Boosters, Inc. and any other persons or organizations providing such information. I understand that the information submitted in this application may be reviewed by an interview team to include GFB Board members. I have read and understand the above statements and have truthfully completed this application.
Print Name: __________________________________________ Date: ___________________________ Signature: __________________________________________________________ Please attach a photocopy of your driver’s license to this application. Please return your completed application and all attachments to: Gorham Football Boosters, Inc. / P.O. Box 413, Gorham, ME. O4038 Or, Scan the completed form and email to [email protected] Board Approved: □ Yes □ No Date Approved: _________________ President’s Signature: __________________________________________ Revision History Change Description
First Publication
Page 3 of 3
11/15/2012
Revised By
Date Revised
