Pleasanton Unified School District 2018-19 Volunteer Clearance Form
This form must be submitted each school year.
CA Driver's License # *
Your answer
CA
Parent's Last Name *
Your answer
Parent's First Name *
Your answer
Date of Birth (Parent) *
MM
/
DD
/
YYYY
Gender *
Address - Street # and Name *
Your answer
Address - City, State and Zip Code *
Your answer
Phone Number (including area code) *
Your answer
School Sites of your children
Signature
By typing my name, I authorize the Pleasanton Unified School District to submit this information to the Pleasanton Police Department to complete the volunteer screening process.
*
Your answer
Date *
MM
/
DD
/
YYYY
Optional
Donation to cover the cost of Volunteer Screening - For your reference, it cost the District $6.00 to conduct a clearance check. If you would like to cover this cost, kindly make your check payable to Pleasanton Unified School District and drop off in the Main Office of your student's school site.
Confidentiality Statement
By typing my name, I understand that in the course of my volunteer association with the Pleasanton Unified School District, I share the responsibility of maintaining student, employee and District confidentiality as to any information, whether written, verbal or by actions observed, which I may have available to me. I further understand that in the course and scope of my volunteer status, I am not to discuss academic, social or other confidential information regarding students or school employees with anyone, including the parents of any student. Any breach of confidentiality will be carefully reviewed by Pleasanton Unified School District and, if substantiated, may result in the termination of my volunteer involvement with the School District. By typing my name, I am also authorizing the Pleasanton Police Department to access criminal history information pertaining to me and determine under Education Code (EC) 35021 any information which would disqualify my application for volunteer position(s). The School District office will be notified by Pleasanton Police Department of the applicant’s clearance status as “Cleared” or “Not Cleared.
*
Your answer
Date *
MM
/
DD
/
YYYY
Submit
Never submit passwords through Google Forms.
This form was created inside of Pleasanton Unified School District. Report Abuse - Terms of Service