Lowndes County Schools Volunteer Procedures:
Definition of a Volunteer:
Volunteer - Anyone providing supervision while actively interacting with students, or anyone having responsibility of students of Lowndes County Schools (LCS). The period of supervision also includes activities outside the normal school day such as field trips, athletic events. etc.
Requirements of volunteers before they are allowed to interact with students:
B. Consent to local background check. Principal will be notified if an issue is identified on the
and mandated reporting law is understood.
A. Volunteers will show a photo id before performing volunteer activities.
B. Schools will designate a certified staff member to maintain the signed statements.
Statement Requiring Volunteer Signature:
Lowndes County Schools Volunteer Statement
After receiving training, I confirm the following:
Volunteer Signature: ______________________________________________
School Designee Signature: _________________________________________
Lowndes County Sheriff’s Office
Criminal History Search
I hereby authorize the Lowndes County Board of Education to receive any Georgia criminal history record information pertaining to me, which may be in the files of any state or local Criminal Justice Agency. Results may be released to Lowndes County Schools – Human Resources Department.
Full Name – Printed
Address City State Zip Code
____ ____ ___________ _________________
Sex Race Date of Birth Social Security Number
Special employment provisions (check if applicable):
☐ Employment with mentally disabled (Purpose Code ‘M’)
☐ Employment with elder care (Purpose Code ‘N’)
Employment with children (Purpose Code ‘W’)
Notary Public, Lowndes County, GA
My commission expires ___________________
Volunteer’s Personal Affirmation
Volunteer’s Name: __________________________________________________________________________________
Please Print Last Name, First Name and Middle Initial
Contact Numbers: __________________________________________ ___________________________________
Instructions: The Volunteer must enter a "Yes" or "No" response to each of the following questions. All questions must have a response (please circle your responses) in order for the volunteer process to continue. Please attach an explanation for any "YES" response.
Please circle the applicable response(s).
♦ Pled guilty;
♦ Entered a plea of nolo contendere;
♦ Entered an Alford plea;
♦ Been found guilty;
♦ Pled guilty to a lesser offense;
♦ Been granted first offender treatment without adjudication of guilt;
♦ Participated in a pre-trial diversion program;
♦ Been found not guilty by reason of insanity; or
♦ Been placed under a court order whereby an adjudication or sentence was withheld?
I affirm that my responses are true and correct. I hereby give permission to Lowndes County Schools to obtain copies of any criminal records relating to me which are held by any local, state or federal government agency. I authorize any such agency or entity to release those records to Lowndes County Schools.
Signature: __________________________________ Date: ________________________
NOTE: This Volunteer’s Personal Affirmation must be completed, signed, dated, received by the school principal and approved by the system before the volunteer activity begins. This Volunteer’s Personal Affirmation will be valid for the current school year. A new Volunteer’s Personal Affirmation will be required for each subsequent school year. Thank you for your cooperation in this matter of mutual concern.