Volunteer Services Form FY 2022-2023

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FY 2022-2023

NOTICE OF VOLUNTEER SERVICES

IMPORTANT INFORMATION: Volunteers MUST be at least 18 years old. Volunteers may not perform bargaining unit work (i.e. duties that the District employs permanent employees to perform).

Fingerprint processing and results from the California Department of Justice and Federal Bureau of Investigation are required prior to the start of service.

Human Resources approval is required prior to allowing the volunteer services to begin.

PLEASE NOTE: This form must be submitted by the volunteer. The supervisor or admin should not fill out the form on behalf of the volunteer.

Volunteer Status*

New Returning

Name*

First Name

Last Name

Address*

Address Line 1

Address Line 2

City

State

ZIP Code

Phone Number*

Email*

Driver License or Government Issued ID #

Date of Birth*

Division*

HR Technician *

Please see below to identify your HR Technician

HR TECHNICIANS BY DIVISIONS

Richard Gonzalez	Ana Florentino	Robert Swain
Admissions & Records	Center for the Arts	Bookstore
Behavioral & Social Sciences	Community Advancement	Facilities
Business Education	Fine Arts	Fiscal Services
CalWorks	Foundation	Grounds
Campus Police	Health Sciences, & Athletics	Information Technology Svcs
Counseling & Student Success	Institutional Research	Mathematical Sciences
Enrollment Services	Learning Resources	MESA
EOPS	Marketing & Communications	Natural Sciences
Federal College Work Study	Nursing	Operations
Financial Aid	President's Office	Outreach
First Year Experience	Professional Development	Purchasing
Human Resources	VP - Academic Affairs	Risk Management
Humanities	VP - Administrative Services	Student Development
Industry & Technology	VP -Student Services	Student Equity
International Student Programs		Student Health Services
Special Resource Center		Student Support Services
Title IX, Diversity, & Inclusion		Warrior Welcome Center

Start Date*

End Date*

Type of work assigned*

Example: Assigned to a specific student, assist an instructor

Supervisor Name*

First Name

Last Name

Dean/Director Name (Must be from El Camino College) *

First Name

Last Name

Dean/Director Email (Must be from El Camino College)*

If unsure of the email, please contact your supervisor

CONVICTIONS

Please indicate if you have ever been convicted, including Nolo contendere plea, of a crime (other than minor traffic violations). Convictions will not necessarily disqualify you from volunteering.

Have you ever been convicted?*

How many convictions do you have?*

Please be as descriptive as possible when answering the conviction questions below. Missing or incomplete information may lead to the denial of volunteering services.

Date of Conviction*

Penal Code Number

Arresting Authority*

City and State of Arresting Authority*

Nature of Offense*

Sentence and/or Fine Imposed*

Remarks*

Date of Second Conviction*

Penal Code Number

Arresting Authority*

City and State of Arresting Authority*

Nature of Offense*

Sentence and/or Fine Imposed*

Remarks*

Date of Third Conviction*

Penal Code Number

Arresting Authority*

City and State of Arresting Authority*

Nature of Offense*

Sentence and/or Fine Imposed*

Remarks*

Date of Fourth Conviction*

Penal Code Number

Arresting Authority*

City and State of Arresting Authority*

Nature of Offense*

Sentence and/or Fine Imposed*

Remarks*

Date of Fifth Conviction*

Penal Code Number

Arresting Authority*

City and State of Arresting Authority*

Nature of Offense*

Sentence and/or Fine Imposed*

Remarks*

Date of Sixth Conviction*

Penal Code Number

Arresting Authority*

City and State of Arresting Authority*

Nature of Offense*

Sentence and/or Fine Imposed*

Remarks*

Date of Seventh Conviction*

Penal Code Number

Arresting Authority*

City and State of Arresting Authority*

Nature of Offense*

Sentence and/or Fine Imposed*

Remarks*

Date of Eighth Conviction*

Penal Code Number

Arresting Authority*

City and State of Arresting Authority*

Nature of Offense*

Sentence and/or Fine Imposed*

Remarks*

Date of Ninth Conviction*

Penal Code Number

Arresting Authority*

City and State of Arresting Authority*

Nature of Offense*

Sentence and/or Fine Imposed*

Remarks*

Date of Tenth Conviction*

Penal Code Number

Arresting Authority*

City and State of Arresting Authority*

Nature of Offense*

Sentence and/or Fine Imposed*

Remarks*

Volunteer Signature

Volunteer Signature*

[clear]

Use your mouse or finger to draw your signature above

DEAN/DIRECTOR REVIEW

Dean/Director Decision*

Approved Denied

Dean/Director explanation for denying this request

Dean/Director Name*

First Name

Last Name

Notes (Optional):

Name of person to contact once volunteer is approved or denied (admin or clerical assistant)*

First Name

Last Name

Email of person to contact once volunteer is approved or denied (admin or clerical assistant)*

DOJ AND FBI RESULTS

Did the volunteer get processed?*

Yes No

Date of DOJ Results*

Date of FBI Results

DOJ / FBI Arrest Notification Received?*

No Yes

DOJ / FBI Arrest Notification

No File Chosen

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Will this request route to HR Director?*

Yes No

This form will not route to the HR Director for the following reason(s)*

Is a ECC 10 Required to be uploaded?

Yes No

ECC 10 Upload

No File Chosen

File uploads may not work on some mobile devices.

Comments (Optional)

HUMAN RESOURCES MANAGEMENT REVIEW

HR MANAGEMENT DECISION*

Approved Denied

Date Approved

Name of HR Management*

First Name

Last Name

Comment(s) from HR Management