Newport-Mesa Unified School District

Volunteer Registration Form
School Year 2017-2018


The Newport Mesa-Unified School District would like to express its appreciation for your willingness to be a volunteer. Volunteers are an essential factor in student success. The practice and policy of the Newport-Mesa Unified School District is to screen all volunteers serving on school and/or District grounds to ensure the health and safety of our students. The information requested below is required for screening through the Department of Justice for sex offenses and proof that you are free from active tuberculosis.
Volunteer Information
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: (i.e. school year 2017-18)
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Athletics Volunteer
FOR MIDDLE AND HIGH SCHOOLS ONLY
   
       
I understand that volunteers are not compensated, and that I may only provide assistance under the direction and supervision of an employee of the Newport-Mesa Unified School District. I understand that my volunteer services are at the discretion of the Board through its designee, the site principal/administrator, and that my services may be terminated at any time. I understand that volunteers are covered under the District's Worker's Compensation Policy.

For Preschool volunteers only: I am in good health and have no physical limitations
In case of emergency, please contact:

Have you ever been convicted of a criminal offense? (A conviction may not necessarily disqualify you from volunteering.)

If you answered "yes" to the question above: In the space please provided below, please enter the following information:

  1. Identify the date, offense and location (City, County and State)
  2. List the appropriate code(s), i.e. penal code(s) and/ or health and safety code(s)
  3. Amount of fine.
  4. Date and length of probation.
  5. Date and length of jail sentence.
Please be aware that certain convictions need not be reported (See Cal. Code Regs., title 2, § 11017 and Labor Code sections 432.7 and 432.8). Regardless of California Code of Regulations, title 2, section 11017 and Labor Code sections 432.7 and 432.8, you must report all convictions for sex and/or drug offenses specified in Education Code sections 44010 and 44011 and any convictions for serious or violent felonies specified in Penal Code sections 667.5 and 1192.7. Convictions set aside pursuant to section 1203.4 of the Penal Code should be disclosed, and such convictions are by law convictions for purposes of this question. If you answered "no" to the question above, please enter N/A in the response area.

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The California Education Code (E.C. 35021) permits, and legal council advises, school districts to conduct a reference check through the Department of Justice of anyone who serves as a volunteer assisting district personnel in the performance of teaching and/or administrative responsibilities. Volunteers who are in contact with students and are under the constant presence of a District employee are screened to determine only that they are NOT registered as a sex offender pursuant to P.C. 290. Copies of the Education Code are available upon request from Human Resources.

In addition, the Health and Safety Code requires that volunteers in contact with students, except those who have infrequent contact (as defined by NMUSD), present a current certificate (within the past 60 days) of being free of active tuberculosis. The certificate must show proof of having had a PPD Mantoux skin test and, if positive, chest x-ray verification with a notice of clearance from the doctor. We do accept TB tests from another District taken within 2 years.

The following locations for TB skin testing throughout the year are suggested:

  1. Private physician, health insurance provider, or local walk-in clinic.

  2. HOPE Clinic, BESST Center, 2045 Meyer Pl., Costa Mesa – free TB skin tests for NMUSD classroom volunteers. Appointments are a must – call (949) 515-6725 for an appointment. Please note that if the Tuberculosis skin test is positive, it is the volunteer’s responsibility to seek follow-up care with a medical provider who will order a chest x-ray and will deem if other treatment is necessary. It is not the responsibility of Newport-Mesa Unified School District to manage follow-up after receiving a Tuberculosis skin test from NMUSD or costs for any follow-up care.

Again, thank you for your willingness to serve the District as a volunteer.

Certification

I hereby certify that all statements made on this form and any attachments are true and complete to the best of my knowledge and authorize investigation of all statements herein recorded.

* Volunteer Location is Required




Thank you for completing the form.

Your request has been submitted.