You must complete the following before we can process your application
SOCIAL SECURITY NUMBER
If you are not a us citizen or permanent resident, please email a picture or scanned document
of your gov't issued photo ID to
volunteer@pcsb.org
Provide your nine (9) digit Social Security Number in the space below with no dashes
in between the numbers.
NOTE OF THE COLLECTION AND USE OF SOCIAL SECURITY NUMBER
Notice is hearby given that Pinellas County Schools collects social security numbers from
individuals for the following purposes, which are either specifically authorized by law
or are imperative for the performance of the district's duties and responsibilities as
prescribed by law: employment eligibility, Criminal Background Screening,
Certification/Contributions Tracking of students as required by State Board Rule, tracking
and reporting of Corporate Tax Credit Scholarship students as required by State Board Rule,
student identification numbers, state directory of new hires, annual report of wages and
individuals, record of remuneration paid to employees, and unemployment benefits.
PREPARED PURSUANT TO SECTION 119.071(5)(a)., F.S. (2007)
CRIMINAL OFFENSES
HAVE YOU EVER : Been arrested, received a summons or a notice to appear
in court, received a criminal traffic citation, been charged, pled nolo contendre, or no
contest to a charge, paid a fine, had adjudication withheld, entered a pre-trail intervention
or diversion program, plead guilty, been found guilty of charges, been convicted or served
time in jail or prison, had charges dismissed nolle prose, not prosecuted, dismissed dropped
or not filed? You must list these matters below no matter how long ago they occurred.
Include any sealed or expunged records.
If you check NO, and offenses appear on the criminal
background screening, your registration will be placed on hold and the processing will be
delayed. If you check YES, please list all offenses,
the disposition (example: no information found, pled guilty, paid fine, plead no contest,
PTI/PTD etc.), the date and location of the offense(s).
* You must answer Yes or No
NOTE: If you leave out ANY part of the
Criminal Offense Form, you will have to re-enter all of your offense
information again.
Check your information before pressing submit!
Pinellas County Schools reserves the right to refuse volunteer assignments to any individual
whether or not he or she has been found convicted of any
offense. In completing this public document, please understand Pinellas County School's
sincere concern for the safety of its students, staff, and visitors.
VOLUNTEER ELIGIBILITY POLICY
The District Office will review all offenses to determine
the outcome of your volunteer status and reserve the right to determine your eligibility
status.
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I MAY NOT VOLUNTEER IF CONVICTED OF any felony sexual related
crimes, (including lewd and lascivious crimes) and felony child abuse.
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I MAY NOT VOLUNTEER IF CONVICTION WAS WITHIN THE LAST TEN (10) YEARS
for other felony crimes and any misdemeanor crimes of a sexual nature, and misdemeanor
crimes related to children.
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I MAY NOT VOLUNTEER IF CONVICTION WAS WITHIN THE LAST FIVE (5) YEARS
for misdemeanor crimes of violence, misdemeanor drug crimes, and misdemeanor crimes
involving weapons.
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I may volunteer, but MAY NOT HANDLE MONEY if crimes involving
worthless checks/petty/retail theft were committed within the past five (5) years.
I may volunteer, but MAY NOT DRIVE students if convicted of a
DUI within the past five (5) years. I MAY NOT DRIVE students if
I have two DUI convictions within the past ten (10) years. I MAY NEVER
DRIVE students if I have three or more DUI convictions.
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Other situations involve a CASE BY CASE REVIEW. This includes
other misdemeanors, multiple convictions, pending charges, and other restrictions.
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APPEAL PROCESS FOR INELIGIBLE VOLUNTEERS - POLICY 9180
Applicants appealing their ineligible status must provide an appeal letter that includes
the circumstances surrounding any/or all criminal offense(s) for which the exemption is
sought. The appeal letter and all supporting materials, e.g. police report, and letters
of recommendations, are to be sent to the Office of Strategic Partnerships District
Volunteer Coordinator. For all questions please email
volunteer@pcsb.org
E-SIGNATURE
By signing below, I agree to follow the rules and
regulations of the volunteer program and that any product produced while a volunteer
shall be the property of the School Board (a work for hire). I understand that all
involvement with students shall be under staff supervision and is restricted to the school
day, on the school grounds, or a school-sponsored activity. I also understand volunteers
are not employees or personnel of the school board. My signature below certifies that I
have reviewed the criminal offense statement and responded truthfully.
FALSIFICATION OR OMISSION OF THIS OFFICIAL PUBLIC DOCUMENT IS A CRIMINAL OFFENSE, CAN
BE PROSECUTED, AND WILL CONSTITUTE GROUNDS FOR VOLUNTEER DISQUALIFICATION
I agree to maintain the CONFIDENTIALITY of student information.
*
required fields
The Pinellas County School Board is a public agency and subject to the Florida Public
Records Act. All records, with certain limited exceptions, are subject to public
viewing.
The School Board of Pinellas County, Florida, prohibits any and all forms of
discrimination and harassment based on race, color, sex, religion, national origin,
marital status, age, sexual orientation, or disability in any of its programs,
services, or activities.
www.pcsb.org