Volunteer Application Broward County Page 4
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4BROWARD COUNTY BOARD OF COUNTY COMMISSIONERS
Finance and Administrative Services Department
Risk Management Division | Safety & Occupational Health Section
ACKNOWLEDGEMENT, AUTHORIZATION AND REQUEST
INSTRUCTIONS
FOR CRIMINAL BACKGROUND INFORMATION
Applicant's Name: _____________________________________________________________________________________________
To BE COMPLETED BY THE SUPERVISOR/PREPARER
Consistent with Broward County policies, an employee may not work in a position which supervises, is supervised by, or influences the
activity of a relative or a spouse employed by Broward County, and may not be promoted to such a position.
Does the candidate or volunteer have a relative or spouse working in this Agency who would supervise, be supervised by, or influence
the candidate or volunteer? (check one)
Yes
No
I certify that I have complied with the provisions of Broward County’s rule of employment of relatives.
_________________________________________________________________
Date: ____________________________
SIGN ►
Signature
MUST BE COMPLETED BY THE HIRING MANAGER
Intern Volunteer or CSW (circle one)
N/A
Job Title: ____________________________________________
BPN: ________________________________________________
N/A
Job Requisition #: _____________________________________
Will applicant work with children as described in applicable Florida Statutes?
Yes
No
Will applicant handle currency (checks, money orders and/or cash)?
Yes
No
Libraries
Division: ______________________________________________ Branch: _______________________________________________
Volunteer
Coordinator: _______________________________________________________________Work Phone: _______________________
_________________________________________________________________
Date: ____________________________
SIGN ►
Signature
Email
RISK MANAGEMENT / HUMAN RESOURCES USE ONLY
Qualified
Offer Withdrawn
Not Qualified
_________________________________________________________________
Date: ____________________________
SIGN ►
Risk Management Signature
ACKNOWLEDGEMENT/AUTHORIZATION BACKGROUND REQ FORM (Rev. November 2015)
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