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PRCA VOLUNTEER CANDIDATE INFORMATION PART 2 PAGE 1 OF 2 PLEASE RETURN VOLUNTEER CANDIDATE INFORMATION TO: PARKS, RECREATION, AND CULTURAL AFFAIRS ADMINISTRATION OFFICE 901 FAIRGROUNDS ROAD (505) 599-1401 VOLUNTEER CANDIDATE RELEASE FORM The City of Farmington conducts an extensive background investigation of criminal history. A criminal conviction does not constitute an automatic bar to placement. Each case is considered individually and based on job requirements. However, failure to answer truthfully will result in disqualification for placement with the City of Farmington Department of Parks, Recreation and Cultural Affairs Volunteer Program. “Crime” as used in this section means any and all felonies, misdemeanors, and serious driving offenses. “Crime” does not include minor civil traffic offenses. If you are unsure how to answer this question, please ask for assistance. “Convicted” means that you have been found guilty by a court or jury, pleaded guilty or no contest to a crime and/or have been sentenced for a crime, whether incarcerated, placed on probation, fined, or received suspended sentence. Have you ever been convicted of a crime, regardless of whether the conviction was later set aside or expunged, in any domestic, foreign or military court? ___Yes ___No Are you pending charges, trial or other court proceedings for any crime, in any jurisdiction, at this time? ___Yes ___No If you answered yes to either or both questions, please give details including the offense(s) for which you were convicted or are currently pending charges, date of conviction, and jurisdiction (court, city, county and state), on a separate sheet of paper. If an offense has been set aside or expunged, please give date of action. CONDITIONS I fully understand that the City of Farmington, to protect its citizens, will conduct a background check of my name through law enforcement agencies and license bureaus and any or all of the following may be required before placement in any sensitive volunteer position: Background Investigation including police and court records Fingerprinting Substance Abuse Testing Motor Vehicle Check Authorization for the Release of Information and Records: I am seeking to become a volunteer with the City of Farmington Department of Parks, Recreation and Cultural Affairs (PRCA) and I hereby direct and authorize the City of Farmington Department of PRCA to conduct a thorough background check through any agencies the City of Farmington Department of PRCA deems necessary. I waive and release any and all manner of actions, causes of action, and demands of every kind, nature and description, arising from any release of criminal records and request there from, whatsoever against the State of New Mexico, City of Farmington Department of PRCA, in both law and equity, which I may have now or in the future. Age: Date of Birth: Social Security Number: Driver’s License Number and State of Issue: Address: Candidate Printed Name: Candidate Signature: Parent/Guardian Signature: (if candidate is a minor) Date: Sign and date in the presence of a Notary Public. Signature indicates understanding and acceptance of the above conditions. State of New Mexico, City of Farmington, County of San Juan Subscribed and sworn to before me this day Date Commission Expires Notary Public FOR OFFICIAL USE ONLY DIVISION REQUIREMENTS: By answering the following questions, HR processes the correct background check YES or NO Questions Answered By: Name / Phone Extension # Is Candidate under 18 years of Age? No background checks or ID badges issued for youth 15 & under. Is Candidate a City of Farmington Employee? Has Candidate ever been employed by the City of Farmington? Will Candidate Work with Youth? Will Candidate Work with the Public? Will Candidate Handle Cash Transactions? Will Candidate Handle Museum Collection or Exhibit Objects? Will Candidate Deliver Meals on Wheels to Homes of Senior Citizens? Will Candidate Operate City Vehicle? ---PAGE BREAK---