Answer YES or NO to each listed item. If the answer is YES to any item, please explain in the area provided, indicating the charge or finding, the date, and the court(s) involved.
1. Have you been convicted of any crimes against persons? (Aggravated murder; first or second degree murder; first or second degree kidnapping; first, second or third degree assault; first second or third degree promoting prostitution; communication with a minor; unlawful imprisonment; simple assault; sexual exploitation of minors; first or second degree criminal mistreatment.)
Answer: ______ If Yes, explain below.
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2. Have you been found in any dependency action under RCW 13.34.30 (2)0 (b) to have sexually assaulted or exploited any minor or to have physically abused any minor?
Answer: ______ If Yes, explain below.
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3. Have you been found by a court in a domestic relations proceeding under Title 26 RCW to have sexually assaulted or exploited any minor or to have physically abused any minor?
Answer: ______ If Yes, explain below.
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4. Have you been found in any disciplinary board final decision to have sexually abused or exploited any minor or to have physically abused any minor?
Answer: ______ If Yes, explain below.
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I have read the information contained herein and pursuant to RCW 9A.72.085, I certify under penalty of perjury under the laws of the State of Washington that the foregoing is true and correct. I authorize Seattle School District to inquire with former employers or references and obtain any and all information regarding my job and/or volunteer related background. I release the Seattle School District, my former employers and all references from any and all liability in obtaining or disclosing such information. I agree that the District may, at its discretion, terminate my volunteer employment if, among other reasons, I provide misleading or incomplete statements.
Volunteer Applicant Signature_________________________ Date: ___________