PARADISE VALLEY UNIFIED SCHOOL DISTRICT NO. 69
15002 North 32nd Street
Phoenix, AZ 85032
John Kriekard, Ed.D.
Revised July 2008
Table of Contents
Superintendent’s Welcome .................................................................. 1
Goals for the Volunteer Program .......................................................... 2
Who Can Volunteer .............................................................................. 2
Volunteer Qualities ............................................................................... 2
Jobs Volunteers Can Do........................................................................ 3
Registration for Volunteers ................................................................... 4
Screening for Volunteers ...................................................................... 4
Emergency/Registration Information Forms ........................................ 4
Distributing and Collecting Forms........................................................ 5
Reasons for Asking the Questions Emergency/Registration Form ...... 5
Volunteer Guidelines ............................................................................ 6
Responsibilities of the Staff .................................................................. 7
Things Volunteers Shouldn’t Do .......................................................... 8
Working Effectively With the Staff ...................................................... 9
Working With the Students ................................................................. 10
Your First Few Days ........................................................................... 11
Teacher/Volunteer Conference Checklist ........................................... 12
Sign-In Procedure ............................................................................... 13
Volunteers Represent the School ........................................................ 14
Insurance Coverage ............................................................................. 14
Rewards of Volunteering .................................................................... 14
Share Your Experience ....................................................................... 14
Volunteer Emergency Information ..................................................... 15
Volunteer Service Statement & Agreement........................................ 16
Conviction Report ............................................................................... 17
Where Individual Excellence Is Our Goal!
District Administration Center
15002 North 32nd Street
Phoenix, Arizona 85032
An Open Letter to All Volunteers in the
Paradise Valley Unified School District
Welcome to the Paradise Valley Unified School District and to your new status as
a volunteer. I am pleased that you have decided to spend some of your very
valuable time with us. By doing so, you allow us to enhance the delivery of
instruction beyond the scope possible under normal funding restrictions. Your
collected experience and expertise is very much needed and appreciated.
This handbook contains important information, which has been compiled in an
effort to make your experience as a volunteer as enriching and rewarding as
possible. I hope you have an opportunity to become familiar with its contents and
to ask any clarifying questions which may arise.
You have my best wishes for a positive and successful experience. Your
participation allows us to continue our quest for excellence. Thank you for being
part of a team effort.
John Kriekard, Ed.D.
What are the Goals of the Paradise Valley
School District’s Volunteer Program?
The major goal of the district Volunteer Program is to assist schools in providing the best
possible education for each student. The services of volunteers are utilized in schools and
district offices to accomplish the following objectives:
• To relieve teachers and support personnel of some non-instructional tasks
• To provide teachers with more time to work with students
• To enrich the curriculum and children’s learning opportunities
• To provide individual attention to those children who need more one-on-one
assistance than the classroom teacher is able to provide
• To promote a school-home-community partnership for quality education
Who Can Volunteer?
Everyone who cares about children and education is a potential volunteer. Prior teaching
experience is not necessary. Volunteers are:
Paradise Valley School Volunteers:
• Recognize that well-educated children are our greatest natural resource
• Have good health and moral character
• Are willing to accept supervision responsibility
• Understand and appreciate the work of the school staff
What Kinds of Jobs Do Volunteers Do?
The Paradise Valley Unified School District offers a wide variety of volunteer opportunities with
a chance to work with children while many other jobs are available for those who prefer not to
work directly with students.
Volunteers choose the jobs that interest them and decide how many hours and days they wish to
contribute. Here is a sample of the jobs, which you may choose:
CLASSROOM INSTRUCTIONAL VOLUNTEER:
Works directly with individual or small groups of students. Volunteers to listen to students read,
reinforce basic math skills, or assist students with written assignments.
CLASSROOM ASSISTANCE VOLUNTEER:
Works with a teacher and performs tasks such as putting up bulletin boards, correcting papers,
preparing teaching aids and special learning materials, duplicating worksheets, and other jobs
which will provide the teacher with more time to plan for and teach students.
OFFICE CLERICAL ASSISTANCE:
Works with the school secretary and office staff to provide support and assistance with duties
such as sorting mail, duplicating school newsletters and flyers, getting classroom supply orders
ready for distribution to teachers, typing, answering the phone, and preparing bulletin boards for
the office area.
SPECIAL EDUCATION VOLUNTEER:
Our school system serves many children with special needs. Children with physical, mental, or
emotional handicaps benefit greatly from the assistance of an extra caring adult. Volunteers are
needed to assist students who attend special education classes in neighborhood schools
throughout the district. For example, physically handicapped students who are unable to write
need volunteers to write for them.
HEALTH OFFICE ASSISTANT:
Works in the health office with the school nurse providing clerical assistance and helping with
health screenings such as vision tests.
LIBRARY OR MEDIA CENTER VOLUNTEER:
Works with the librarian or media center specialist by repairing and shelving books, doing
clerical work or preparing bulletin boards and displays. Volunteers may choose to work directly
with students helping them to locate and use library materials or assisting them with research
Volunteers assist with the art program, educational TV, computer instruction, and music. They
prepare materials for creative arts programs and for science and social studies classes.
Volunteers also serve as guest speakers.
Every Volunteer Must Register
Every volunteer who works for the Paradise Valley Unified School District must complete a
Volunteer Registration and Application Form (pages 15-18) before he/she begins work. (This
includes parent volunteers.) This information is especially important in the event you become ill
or are involved in an accident while on campus.
We also want to make certain that you are aware of our district volunteer policies and the other
information, which are included in this handbook. Please read the handbook carefully before
signing the Volunteer Service Agreement on page 16.
After completing the Volunteer Emergency Information form, return it to the school secretary
where it will be kept on file for the remainder of the school year. The emergency card and
conviction report should be filled out each year.
Non-Parent Volunteer Screening
In accordance with our district policy, new volunteers who do not have a child in the school
where they will be working MUST be screened by the Human Resources Department before
Non-parent volunteers should complete a Volunteer Registration and Application Form (pages
15-18) before he/she begins work. After completing this paperwork return it to the school
secretary. The school submits a Personnel Action Form, including the volunteer’s phone number
to the Human Resources Department. Human Resources will contact him/her to make
arrangements for processing paperwork and fingerprinting. The volunteer is not charged
Emergency/Registration Information Forms
The volunteer registration/emergency information forms serve two purposes:
1. EMERGENCY - if a volunteer becomes injured or ill while on campus, it will be
important for the school to have this information. Your school already keeps a similar
card on file for each member of your staff.
2. REGISTRATION - this form contains other necessary information to ensure the fact that
volunteers have read the policies.
Distributing and Collecting Forms
• Because health conditions, addresses, choice of family physician, etc. change frequently,
volunteers are required to complete a new registration/emergency information form each
• New and returning volunteers will be given a form on the first day they work at the school
EACH YEAR. Blank forms will be located near your volunteer sign-in notebook. A sign on
the cover of the notebook will direct volunteers to pick up a form, fill it out, and return it.
• Completed forms will be filed in the school health office near the student and staff
emergency cards. In the event of an emergency, (or if other information is needed) the staff
will know where to find the forms.
• It is the volunteer’s responsibility to return the emergency form and the school coordinator’s
responsibility to see that the forms are returned to the school nurse. It is not the
responsibility of the school nurse to make certain that they have been returned. We do ask
that school nurses make a place in their emergency file boxes for volunteer forms. Most
schools have one or more volunteers who would be happy to put the volunteer forms in
Reasons for Asking the Questions Included
on the Emergency/Registration Form
It is imperative that each volunteer understand his/her responsibilities and limitations.
Volunteers must be aware of and agree to abide by all district volunteer policies and regulations.
When volunteers sign this form, they are telling us they have received and read the district
The first time an individual begins working as a Paradise Valley School volunteer, he/she will be
given a Volunteer Handbook. Each year that the volunteer returns, he/she will receive “update”
information. Returning volunteers will not receive a handbook every year.
Volunteers are asked if they have a child attending Paradise Valley School District. NEW
volunteers, who do not have a child attending school in the district, must be screened by the
Human Resources Department before beginning a volunteer assignment. (A new volunteer is any
volunteer who has not worked at the schools in previous years.)
Some people who have been convicted of a crime should not be working with children. For this
reason, we ask volunteers to explain the nature of any crimes for which they were convicted.
For recognition purposes, it is often helpful to know how many years a volunteer has served at a
Teachers and students may wish to do something special for a volunteer’s birthday. For this
reason we ask the volunteer to provide the month and day of birth. Attached is a copy of the
volunteer registration/emergency information form. Please return the completed form to the
SUPERVISION OF VOLUNTEERS
School volunteers always work under the direct supervision of the professional staff at each
school and only with those teachers who have requested the services of the volunteer. The
district is responsible for the education, safety, and well being of each student. For this reason,
you can understand why the teacher, principal, or district volunteer coordinator must dismiss any
volunteer whose actions are not in the best interest of the school or students.
As you work with the staff and students, information of a confidential matter may be shared with
you. The problems, abilities, relationships, and confidences of students, their parents, and the
staff should never be discussed with anyone who does not have a professional right or need to
know them. Like teachers, volunteers are bound by a code of ethics to keep confidential matters
within the school. The staff and students need to know they can trust you.
Please do not discuss a child’s school progress or difficulties with his/her parents. This is the
Occasionally, a child might confide in you about family matters or personal problems. Keep this
confidential, too. If you feel that it is vital for the school to have this information in order to help
the student, discuss the child’s conversation (in private) with the teacher or principal.
Students rarely have behavior problems while working with volunteers. However, our schools
have detailed discipline plans and the responsibility for discipline rests with the professional
staff. Volunteers may not discipline students. Please make the teacher aware of any discipline
problem that might arise while you are working with a student.
Staff restrooms are available for volunteers. We ask that you not use student restrooms.
DISMISSAL OF STUDENTS
Volunteers may never dismiss a student from school. Children who must leave school early for
any reason must receive permission from the school office and sign out before leaving. Under
no circumstances may a volunteer take a student off campus. Volunteers may not walk or drive
students to their homes unless the child’s parent has notified the school office in advance and
given permission for the volunteer to do so.
DRESS AND BEHAVIOR
Take your lead from the professional staff and dress appropriately for the job you are doing. It is
best to neither overdress nor underdress. Casual clothing is fine, but we ask that attire be neat
and conservative. Your appearance should attract no undue attention. Keep in mind that you are
in a position to set an example for students. Your speech and behavior should serve as good
models for them to follow.
If you are not feeling well, don’t try to keep up your volunteer duties in spite of an illness.
You’ll accomplish more in the long run if you allow yourself time to recuperate. (Do call in
advance to let the teachers know you won’t be coming in at your scheduled time, however.)
Schools are particularly concerned about keeping students and staff healthy. This is another
reason for staying away from school if you have a contagious illness.
Before you agree to volunteer, carefully consider the commitment you are making. The work
volunteer’s do is important. Whether they work in the classroom, main office, media center, or
health office, the staff and students quickly become dependent upon volunteer assistance.
Don’t promise to volunteer more time than you will be able to follow through with. It’s better to
start out with a few hours a week and gradually build up to more hours or days if you find you
have the additional time.
Please be prompt and consistent! We know there will be times when you will be ill, on vacation,
or unable to volunteer for one reason or another. However, please let the staff know as far in
advance as possible. Remember, the teacher will be expecting you on the days you are
scheduled to volunteer, and so will the children! If you fail to show up at your appointed time on
your appointed day, everyone is disappointed.
Please telephone the school office and leave a message for the teacher or staff member
with whom you work. Let them know in advance if you will be unable to volunteer.
FIND OUT ABOUT SCHOOL RULES
Become familiar with the rules and policies of the school where you work. It’s a good idea to
read through the school’s handbook. Ask your supervising teacher to explain the school’s policy
for smoking, use of telephones, eating facilities, fire drills, and emergency procedures.
Use reasonable judgment in making decisions when there appears to be no policy or when the
policy is not communicated. As soon as possible, consult with the supervising teacher for future
Responsibilities of the Staff
Volunteers are an important part of the educational team. The suggestions and opinions of
volunteers are always welcome. It is the professional staff, however, that is held responsible by
law for decisions that are made regarding the instruction of students and the management of the
school. For this reason, volunteers always work under the direct supervision of teachers and
Is There Anything Volunteers
YES!! The professional staff at your school is responsible for everything that goes on in your
building including student instruction, safety, and discipline. Volunteers supplement and support
the program but may not:
• Provide the curriculum or teaching plan
• Discipline students
• Take charge of the classroom for any length of time
• Have access to materials in student’s permanent, hard-copy, records file or
electronic records file (psychological records, grade cards, health history, etc.)
• Diagnose student needs
• Evaluate achievement
• Counsel students
• Discuss student progress with parents
• Drive district vehicles
A volunteer is never considered a substitute for a member of the school staff.
Working Effectively With the Staff
The staff will appreciate your willingness to be a part of the educational team. Teachers and
support personnel will come to depend upon your assistance. Here are some tips for working
effectively with the staff.
GETTING TO KNOW YOU
Let the staff know what types of jobs you are interested in doing and what your special skills are
so they can utilize your talents.
A NEW EXPERIENCE FOR YOU, AND PERHAPS FOR THE TEACHER
If you’ve never been a school volunteer before, you’ll find that there are many new and exciting
things to learn about the job. Please be aware that some staff members have never had an
opportunity to work with volunteers before. This will be a new experience for them, too, as they
learn how to utilize the services of a volunteer.
BE A GOOD COMMUNICATOR
The staff will welcome your questions and comments. If you don’t understand something,
always ask. Volunteering should be an enjoyable and rewarding job. If you are unhappy or
concerned about something, discuss the situation with the staff.
ROUTINE TASKS ARE IMPORTANT
The staff often relies upon volunteers to do the “routine” jobs such as preparing learning aids and
organizing materials. Because volunteers are able to assist with these jobs, teachers are free to
spend more time working with students or planning for quality instruction.
WE ALL HAVE DIFFERENT WAYS OF DOING THINGS
When you have been assigned a task, make certain you know exactly how the teacher wants the
job done. Ask for clear directions and if necessary, ask that the teacher give you samples or
demonstrate how tasks are to be performed.
TRY SOMETHING NEW
The opportunity to learn new skills is one of the benefits of being a school volunteer. Be willing
to try new tasks assigned by the staff, but accept only as much responsibility as you feel
BE PROMPT AND 100 PERCENT DEPENDABLE
Come when you say you will. Give the staff plenty of notice when you won’t be available at
your scheduled time.
If You Work With Students...
CALL STUDENTS BY NAME AT EACH OPPORTUNITY
A child’s name is very important. Make every effort to pronounce and spell each child’s name
CLOSELY OBSERVE THE TECHNIQUES USED BY THE TEACHER
Try to model these instructional methods when working with students.
ACCEPT CHILDREN AS THEY ARE
Each child is unique. Some children may be very different from your own child. Be ready to
accept these differences in background, values, vocabulary, and aspirations.
ENCOURAGE AND PRAISE STUDENTS
Use positive comments that will make children feel good about themselves even when they are
having difficulty. Avoid saying anything that will make student feel bad about themselves or
their ability to learn. Be ready to praise children for even the smallest successes! Let each child
know that you care about him/her through the use of verbal affirmation.
CHILDREN NEVER FORGET
If you promise them something, be prepared to keep the promise. Be careful not to make
promises that you will be unable to keep.
ENCOURAGE STUDENTS TO DO THEIR OWN THINKING
Try not to give students the answers before they have had an opportunity to solve problems on
their own. Give children plenty of time to answer your questions. Silence often means that a
child is thinking. Beware of occasional students who may try to get you to do their work for
FOLLOW THE TEACHER’S LEAD
Always be consistent with the teacher’s rules for classroom behavior. Don’t allow children to do
things their teacher doesn’t allow. Remember, the teacher is always available and ready to
handle discipline problems. Make sure the children with whom you are working do not disturb
the rest of the class.
REINFORCE GOOD BEHAVIOR
When children (especially younger students) are behaving well, always let them know how
proud you are of them and how much you appreciate their effort. This will encourage them to
try even harder. If possible, do not pay attention to a child who shows minor misbehavior
problems, but do note things the child is doing well and praise him/her for it.
IT’S OKAY IF YOU DON’T KNOW ALL THE ANSWERS
Admit to the children that you don’t know the answer or aren’t sure what to do. Work the
answers out together with students or feel free to ask the teacher for assistance.
KEEP STUDENTS ON TASK
You’ll want the children to learn as much as possible during the short time they spend with you.
Keep the lesson or activity moving. Try to avoid letting one or more students get you or the
group off the track for long periods of time by discussing topics that have nothing to do with the
SUPERVISE STUDENTS CAREFULLY
Under no circumstances should you leave a student or small group of students without
supervision. Always be fully aware of what students are doing at all times.
TO GIVE OR NOT TO GIVE
Your positive words of encouragement will go a long way in helping students to become excited
about learning. Younger children may also enjoy stars, stickers, stamps, and especially little
notes of praise from the volunteer. You and the teacher can discuss the use of these motivational
Please do not give students food without checking with the teacher. Volunteers may not give
students advertisements or fund solicitations.
Your First Few Days
Starting a new job is always exciting and can even be a bit frightening. The first days are usually
the busiest because there are so many new people to meet and things to learn about. As you
become familiar with the school and your assignment, you will feel more at home. Here are
SET UP A TIME TO MEET WITH YOUR SUPERVISING TEACHER
When you meet with your supervising teacher, plan to discuss the teacher/volunteer conference
checklist. If you have any questions or concerns, add them to the list now so you won’t forget to
bring them up at the conference.
You may want to take a tour of the building with your supervising teacher so you’ll learn your
way around and will have an opportunity to be introduced to key staff members.
TAKE TIME TO OBSERVE
If you’ll be working with students, the first day or two in the classroom will probably be best
spent in observing the teacher and children. You’ll become familiar with the teaching style your
supervising teacher uses. You’ll see what acceptable behavior is for students and what is not,
how much freedom is allowed and what the daily routine is like.
While you are observing, you can also work on various tasks such as correcting papers, filing,
and preparing learning materials. You’ll want to get up from time to time and move among the
students as they are working. Don’t hesitate to ask individual children what they are doing.
Students love to have the opportunity to explain their assignments.
Teacher/Volunteer Conference Checklist
Plan to discuss these topics when you meet with the teacher:
___ Days and times you will work
___ How will you let the teacher know if you are unable to work at your assigned time?
___ Alternate plans for days when the teacher is absent and a substitute teacher is in charge of
___ How the teacher will tell you of your days’ assignment (plan book, folder, note, etc.)
___ How you will tell the teacher what you have accomplished during the day, performance of
students with whom you have worked, need for materials, etc.
___ A safe and secure place to leave your personal belongings
___ Location of materials and workspace for your use
___ Classroom rules and teacher’s discipline policy
___ Procedure for letting the teacher know when a child is having a discipline problem that
requires his/her attention
___ Daily class schedule
___ Alternate plans if a student with whom you work is absent
___ Student roll and/or seating chart
Other questions or concerns...
Each volunteer must sign in and out in the school office or an alternate area designated by the
school for this purpose each time he/she comes on campus to volunteer. The district must have a
record showing the days and hours each volunteer works. For security reasons, and in case of an
emergency, it is important for administrators to know who is on campus and why.
Lastly, a record of each volunteer’s hours enables the school to evaluate its volunteer program
and recognize volunteers for their contribution of time.
Each school has a sign-in notebook containing volunteer record sheets. You will have your own
record sheet to record your hours. A sample sheet has been reproduced below.
DON’T FORGET!! Sign in and out each time you volunteer. We know it takes a few extra
steps and minutes to follow this procedure, but it is very important.
Start recording your hours here.
(Record to the nearest half hour.)
DATE TIME IN TIME OUT HOURS
Volunteers Represent the School
As a volunteer, you not only serve the needs of the children, you also provide a vital link
between the school and the community. Students, their parents, and the community will view
you as a representative of the school. They will pay close attention to what you say about the
staff and the educational programs.
Sometime the community hears about the negative aspects of education or stories about the few
students who misbehave. Because of your volunteer experience, you’ll be able to share the many
positive things that students and staff are doing. You’ll have an opportunity to let the
community know what’s going right in their schools! (Remember not to share confidential
Medical and Workers’ Compensation
The district does not carry medical insurance for volunteers; however, volunteers must be
registered at their school and a record of volunteer hours must be maintained for workers’
compensation coverage. That’s why it’s important for you to sign in and out each time you
volunteer. If you have questions about this liability coverage, feel free to call the Human
Per Resolution No. 107 (adopted 2/1/96) of the Paradise Valley Unified School District, I am
deemed to be entitled to workers’ compensation benefits per A.R.S. 23-1021 if I incur personal
injury by an accident arising out of and in the course of my volunteer employment with the
Rewards of Volunteering
We know you will enjoy your volunteer experience. Each year, many volunteers tell us they
receive so much more than they give to the program. By sharing your time with our students and
staff you will:
Be given the opportunity to use your skills and talents
Gain a better understanding of how children learn
Have a chance to meet and work with teachers and other volunteers
Know that the work you are doing directly affects the quality of education for the children of our
Have a great chance to learn valuable new skills that you might use in future endeavors
Share your Experience
If you have friends or relatives who might be interested in volunteering in our schools or in one
of our district offices or departments, please ask them to call the Paradise Valley Unified School
District, Human Resources Department at 602.449.2171.
VOLUNTEER REGISTRATION INFORMATION
Last First Middle Initial
City State Zip
Home Phone: Cell #:
School you wish to volunteer at:
Does your student attend this school? □ Yes □ No
In case of emergency, please contact:
Home phone: Cell #:
Illness or health condition of note:
I give permission to have emergency care administered.
AFTER COMPLETION PLEASE RETURN THIS FORM TO SCHOOL SECRETARY
Paradise Valley Unified School District No. 69
Statement and Agreement
I make this Statement and Agreement in order to provide and to be authorized to perform the
following uncompensated services to the Paradise Valley Unified School District:
In performing the specified volunteer service, I acknowledge:
• That I am 18 years of age or older and know of no reason which would prevent me from
performing the tasks required as detailed in the Volunteer Job Description.
I am presently a student enrolled in the Paradise Valley School District system.
• That I have acquainted myself with what is required to perform those tasks, and I represent
that I have the skill and ability to perform them.
• That I assume full responsibility for my own safety and the safety of others.
• That per Resolution No. 107 (adopted 2/1/96) of the Paradise Valley Unified School District,
I am entitled to workers’ compensation benefits per A.R.S. 23-1021 if I incur personal injury
by an accident arising out of and in the course of my volunteer employment with the District.
• That I will perform the volunteer service in compliance with the standards and specifications
established, or approved, by the District, and will honor the direction of District official, to
suspend or terminate service.
Volunteer’s Signature Date
Please return this form to the school secretary
Because of the tremendous responsibility Paradise Valley Unified School District has to its
school children and community, the following information is needed from all volunteers
regarding convictions*. A record of conviction does not prohibit volunteering; however,
failure to complete this form accurately and completely can mean disqualification from
becoming a volunteer or can be cause for consideration for dismissal if accepted for
volunteer service. Volunteers must report any convictions that occur subsequent to the time
they initially completed this form. Questions regarding this information should be directed
to the Director of Human Resources at the district office.
Other names used/known by:
Dates of Usage:
Social Security Number: Date of Birth:
(Required only for overnight or out-of-state
trips and/or non-parent volunteers)
2. Have you ever been convicted or plead guilty or “no contest” to any offense in a court
3. Have you ever been convicted of a sex, alcohol or drug related offense?
4. Have you ever been convicted of a dangerous crime against children as defined in
If any of the boxes above are marked "YES", fill in the information
on the following page and attach a letter of explanation.
CONTINUED ON PAGE 18
CONVICTION REPORT (Continued)
1. Conviction Charge
Date of Conviction
Court of Conviction
Amount of Fine Length of Jail Term
Length & Terms of Probation
2. Conviction Charge
Date of Conviction
Court of Conviction
Amount of Fine Length of Jail Term
Length & Terms of Probation
*CONVICTION means the final judgment on a verdict or a finding of guilty, or a plea of nolo contendere, in any state or
federal court of competent jurisdiction in a criminal case, regardless of whether an appeal is pending or could be taken.
Conviction does not include a final judgment, which has been expunged by pardon, reversed, set aside, or otherwise
**A.R.S. 13.604.01 requires applicants to give notice of any conviction for dangerous crimes against children. These crimes
are defined as second degree murder, aggravated assault, sexual assault of a child, sexual conduct with a minor, sexual
exploitation of a minor, child abuse, kidnapping and sexual abuse.
I AUTHORIZE INVESTIGATION OF ALL THE STATEMENTS IN THIS APPLICATION INCLUDING INVESTIGATION OF
PREVIOUS EMPLOYMENT EXPERIENCES IF I AM CONSIDERED AS A VOLUNTEER. I CERTIFY THAT THE ABOVE
ANSWERS ARE TRUE AND COMPLETE AND UNDERSTAND THAT FALSIFICATION OR OMISSION OF FACTS ON THIS
APPLICATION SHALL BE CONSIDERED SUFFICIENT CAUSE FOR DISQUALIFICATION OR DISMISSAL. I FURTHER
AGREE TO TAKE ANY FUTURE PHYSICAL EXAMINATIONS THE DISTRICT MAY DEEM NECESSARY. REFERENCES
AND PERSONAL INFORMATION WHICH BECOME A PART OF THIS RECORD ARE TO BE REGARDED AS
CONFIDENTIAL AND WILL NOT BE REVEALED.
Please return this form to the school secretary