A COPY OF VALID GOVERNMENT ISSUED PHOTO IDENTIFICATION MUST BE ATTACHED TO COMPLETE THIS APPLICATION. Name __________________________________ Date ___________________ Address ________________________________________________________ City ____________________________ State _________Zip _____________ Social Security # (mandatory with First Advantage ) _______________ Cell Phone Business PhoneHome Phone: _____________ E-mail Address: Date of Birth ____________________________________________________ Occupation _____________________________________________________ Employer _______________________________________________________ Address ________________________________________________________ Special professional training, skills, hobbies: ___________________________ _______________________________________________________________ Community affiliations (Clubs, Service Organizations, etc.): _______________________________________________________________ Previous volunteer experience (including baseball/softball and year): _______________________________________________________________Do you have children in the program? Yes No If yes, list full name and what level? _____________________________________________________ Special Certification (CPR, Medical, etc.): ______________________________Do you have a valid driver’s license: Yes No Driver’s License#: ________________________________State ___________Have you ever been convicted of or plead guilty to any crime(s) involving or against a minor?: Yes NoIf yes, describe each in full: _________________________________________ _______________________________________________________________Are there any criminal charges pending against you regarding any crime(s) involving or against a minor? Yes No If yes, describe each in full:______________ __________________________________________________________________Have you ever been refused participation in any other youth programs? Yes No If yes, explain: ___________________________________________________ _______________________________________________________________In which of the following would you like to participate? (Check one or more.)

League Official Coach Umpire Field Maintenance 

Manager Scorekeeper Concession Stand Other 

 Please list three references, at least one of which has knowledge of your participation as a volunteer in a youth program:

Name/Phone

______________________________________________________________________

______________________________________________________________________

______________________________________________________________________

IF YOU LIVE IN A STATE THAT REQUIRES A SEPARATE BACKGROUND CHECK BY LAW, PLEASE ATTACH A COPY OF THAT STATE’S BACKGROUND CHECK. FOR MORE INFORMATION ON STATE LAWS, VISIT OUR WEBSITE: 

http://www.littleleague.org/learn/programs/childprotection/state-laws-bg-checks.htm

AS A CONDITION OF VOLUNTEERING, I give permission for the Little League organization to conduct background check(s) on me now and as long as I continue to be active with the organization, which may include a review of sex offender registries (some of which contain name only searches which may result in a report being generated that may or may not be me), child abuse and criminal history records. I understand that, if appointed, my position is conditional upon the league receiving no inappropriate information on my background. I hereby release and agree to hold harmless from liability the local Little League, Little League Baseball, Incorporated, the officers, employees and volunteers thereof, or any other person or organization that may provide such information. I also understand that, regardless of previous appointments, Little League is not obligated to appoint me to a volunteer position. If appointed, I understand that, prior to the expiration of my term, I am subject to suspension by the President and removal by the Board of Directors for violation of Little League policies or principles.

Applicant Signature________________________________________Date__________

If Minor/Parent Signature___________________________________Date __________

Applicant Name(please print or type)________________________________________

NOTE: The local Little League and Little League Baseball, Incorporated will not discriminate against any person on the basis of race, creed, color, national origin, marital status, gender, sexual orientation or disability.

 LOCAL LEAGUE USE ONLY:

Background check completed by league officer ________________________________ on ____________________________________________________________________System)s) used for background check (minimum of one must be checked):Regulation I(c)(9) Mandates First Advantage or another provider that is comparable

*First AdvantageSex Offender Registry Data along with a National Criminal Records check of at least 281 million records 

*Please be advised that if you use First Advantage and there is a name match in the few states where only name match searches can be performed you should notify volunteers that they will receive a letter directly from LexisNexis in compliance with the Fair Credit Reporting Act containing information regarding all the criminal records associated with the name, which may not necessarily be the league volunteer.Only attach to this application copies of background check reports that reveal convictions of this application.