HESPERIA UNIFIED SCHOOL DISTRICT

VOLUNTEER INFORMATION FORM

TYPE or PRINT using dark ink only. This application must be signed and dated by the volunteer applicant. Please note

that this form must be submitted every year at each site where the volunteer wishes to assist.

STUDENT’S NAME: __________________________ VOLUNTEER SITE: _________________________

ADDRESS: ________________________________________________________________________________

DRIVER’S LICENSE # (COPY OF PICTURE MUST BE ATTACHED): _______________ DATE OF BIRTH: _______________

Height: __________ Weight: __________ Hair Color: __________ Eye Color: __________

PHONE NUMBER: (home/cell) _______________________ PHONE NUMBER: (work) _________________

In case of emergency, please notify: Name: ____________________________

Phone: _______________________________

( ) Yes ( ) No Can you perform the essential functions of the volunteer position with or without reasonable

accommodations? If you require accommodations, what reasonable accommodations do you require to

perform this volunteer position?

Applicant’s Statement

I certify under penalty of perjury that the answers given herein are true and complete to the best of my knowledge. I

authorize investigation of all statements contained in this form as may be necessary. I understand that this is not

intended to be a contract for employment. I acknowledge that I am required to abide by all the rules and regulations of

the State of California and the Hesperia Unified School District and that I am not to commence any Hesperia Unified

School District volunteer activity until I have been approved by the Board of Trustees.

Volunteer Signature: _____________________________________ Date: __________________

Site Administrator’s Signature: ________________________ Approval: ( )Yes ( )No Date: __________________