New Submission

Site Typefield type single line
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District-Wide Approverfield type single line
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Approverfield type single line
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Approver Usernamefield type single line
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School Site:*field type drop-down
First Name:*field type single line
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Last Name*field type single line
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Nicknamefield type single line
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Are you a parent/guardian or other family member of an ECS student?*field type radio button
Are you a parent/guardian or other family member of an ECS student?YesNo
Are you a current / recent ECS employee?*field type radio button
Are you a current / recent ECS employee?YesNo
Are you volunteering through the USCG PIE program?*field type radio button
Are you volunteering through the USCG PIE program?YesNo
Are you applying to be a volunteer athletic coach?field type radio button
Are you applying to be a volunteer athletic coach?YesNo

Athletic Coach References

Please provide one or more athletic coach reference(s) who can speak to your qualifications in this role

	Name*field type single line	Phone*field type single line	Email*field type email	Organization/Company*field type single line
Row 1×	Name*field type single line Input blocked. Maximum character limit of 4000 characters reached.	Phone*field type single line Input blocked. Maximum character limit of 4000 characters reached.	Email*field type email	Organization/Company*field type single line Input blocked. Maximum character limit of 4000 characters reached.	×

Add Reference

If you had previously filled out a volunteer application and been cleared to volunteer before this digital application was available, you may have been asked to fill this out to add or renew a field trip driver form. If that is the case, please indicate that on the question below.

Incorrectly indicating that you are already a cleared volunteer could significantly delay your volunteer application.
Are you already a cleared volunteer?*field type radio button
Are you already a cleared volunteer?YesNo

	Student Name*field type single line	School*field type drop-down	Relationship*field type single line
Row 1×	Student Name*field type single line Input blocked. Maximum character limit of 4000 characters reached.	School*field type drop-down	Relationship*field type single line Input blocked. Maximum character limit of 4000 characters reached.	×

Add Another Student

Date of Birth:*field type date
Phone Number:*field type number
Email Address:*(?)field type email
Confirm Email Address:*field type email
Street Address:*field type single line
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Address Line 2:field type single line
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City:*field type single line
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State:*field type single line
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Zip:*field type number
Please list the school programs you are interested in serving. Include type of program and age of students, for example, Special Education, Pre-school age students.*field type multi line
Please explain why you are interested in volunteering with Eureka City Schools.*field type multi line
Please list any special training you have had that may benefit you in your volunteer services.*field type multi line
Please list any physical or medical conditions that may inhibit full participation in our school environment.*field type multi line
Other than routine traffic violations, have you ever been convicted of a crime?*field type radio button
Other than routine traffic violations, have you ever been convicted of a crime?YesNo
If yes, please explain:*field type multi line

Days and Times You Are Available to Volunteer:

	Mondayfield type single line	Tuesdayfield type single line	Wednesdayfield type single line	Thursdayfield type single line	Fridayfield type single line
row 1	Mondayfield type single line Input blocked. Maximum character limit of 4000 characters reached.	Tuesdayfield type single line Input blocked. Maximum character limit of 4000 characters reached.	Wednesdayfield type single line Input blocked. Maximum character limit of 4000 characters reached.	Thursdayfield type single line Input blocked. Maximum character limit of 4000 characters reached.	Fridayfield type single line Input blocked. Maximum character limit of 4000 characters reached.

Other Time Availability Information:field type single line
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Have you lived in California for the past 12 months?*field type radio button
Have you lived in California for the past 12 months?YesNo
Signature:*field type signature

Do you plan to transport students as part of your volunteering for Eureka City Schools?*field type radio button
Do you plan to transport students as part of your volunteering for Eureka City Schools?YesNo

Driver's First Name:*field type single line
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Driver's Last Name:*field type single line
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Driver's License Number:*field type single line
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Driver's License State:*field type drop-down
Driver's License Expiration Date:*field type date
Vehicle Make/Model*field type single line
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Vehicle License Plate*field type single line
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Name of Insurance Company:*field type single line
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Insurance Policy Number:*field type single line
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Insurance Policy Expiration Date:*field type date

Insurance Coverage:

	Bodily Injury - Per Person*field type number	Bodily Injury - Per Occurrence*field type number	Medical Payments*field type number	Property Damage*field type number
row 1	Bodily Injury - Per Person*field type number	Bodily Injury - Per Occurrence*field type number	Medical Payments*field type number	Property Damage*field type number

I certify that the above information is correct and that the insurance coverage is in force. I understand I must have liability insurance coverage in force and agree to advise the District, in writing, of any changes in the above information. I further certify that the above vehicle is mechanically safe.
I certify that I am at least 21 years old and my DMV record does not contain a conviction of reckless driving or driving under the influence of drugs or alcohol within the past five years.
I certify that I nor any other person shall smoke or have in his/her immediate possession a lighted pipe, cigar, or cigarette containing tobacco or any other plant when there is a minor in the motor vehicle, whether the motor vehicle is in motion or at rest.
I shall ensure that a child who is under age 6 or under 60 pounds, unless exempted in accordance with Vehicle Code 27360 or 27363, is properly secured in a rear seat in an appropriate child passenger restraint system meeting federal safety standards.
I understand that if I drive my personal automobile while on school business and I am involved in an accident, by law my own insurance policy is used first. The District liability policy would be used only after my liability policy limits for my vehicle have been exceeded. The District does not insure, nor is it liable for, comprehensive and collision coverage.
I certify that the above information is correct and that I have a VALID California Driver's License, ACTIVE automobile insurance, and seat belts for EACH individual.
Driver's Signature:*field type signature
Is The Vehicle Owner Different From The Driver?*field type radio button
Is The Vehicle Owner Different From The Driver?YesNo
Vehicle Owner First Name*field type single line
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Vehicle Owner Last Name*field type single line
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Vehicle Owner's Signature:*field type signature

TB Testing: After your application passes initial approval, you will receive information with dates, times, and locations that a district nurse is available to administer a free tuberculosis (TB) test, which is a requirement to volunteer for Eureka City Schools.
Fingerprinting: After you have completed the TB test, you will be emailed a fingerprint form that you will need to print and bring to a Live Scan fingerprint location. Information on Live Scan locations can be found here.
You cannot complete the fingerprint portion of the application process before completing your TB test.

Please double-check the email address you have provided on your application.
The form required to be fingerprinted can only be emailed to you if you provide the correct email address.

Verification failed. Please check the checkbox.

EUREKA CITY SCHOOLS VOLUNTEER APPLICATION FORM

Days and Times You Are Available to Volunteer: