Sideline Learning

Screening Application Form

Participants who apply to volunteer or work within certain positions within the Organization must complete this screening form. If the participant is applying for a new position within the organization, a new form must be submitted. Failure to disclose truthful information below may be considered an intentional omission and the loss of volunteer or emplyment responsibilities or other privileges.

Required fields are marked with a *

E-Mail Address *

First Name *

Middle Name

Last Name *

Street *

City *

Province *

Postal Code *

Date of Birth *

Gender Identity *

Email *

Phone *

Position Sought: *

Director
Club Coach
League Coordinator
Committee Chair
Committee Volunteer
Athlete Support Personnel
Officials
Employee

1.) Do you have a criminal record? if so, please complete the following information for each conviction.

Attach additional pages as necessary.

Name or Type of Offense:

Name and Jurisdiction of Court/Tribunal:

Year Convicted

Penalty or Punishment Imposed

Further Explanation

2. Have you ever been disciplined or sanctioned by a sport governing body or by an independent body (e.g., private tribunal, government agency, etc.) or dismissed from a coaching or volunteer position?

If so, please complete the following information for each disciplinary action or sanction. Attach additional pages as necessary.

Name of disciplining or sanctioning Body

Date of discipline, sanction or dismissal

Reason for discipline, sanction or dismissal

Penalty or Punishment Imposed:

Further Explanation

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3. Are criminal charges or any other sanctions, including those from a sport body, private tribunal or government agency, currently pending or threatened against you? If so, please complete the following information for each pending charge or sanction.

Attach additional pages as necessary.

Name or Type of Offense:

Name and Jurisdiction of Court/Tribunal:

Name of disciplining or sanctioning body:

Further Explanation:

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Choose file

Privacy Statement

By completing and submitting this Screening Disclosure Form, I further certify that I will consent and authorize the Organization to collect, use and disclose my personal information, including all formation provided on the Screening Disclosure Form as well as my Enhanced Police Information Check and/or Vulnerable Sector Check (when permitted by law) for the purpose of screening, implementation for the Screening Policy, administering membership services, and communicating with National Sport Organizations Provincial Sport Organizations, Sport Clubs, and other organizations involved in the governance of sport. The organziation does not distribute personal information for commercial purposes.

Certification

I hereby certify that the information contained in this Screening Disclosure From is accurate, correct, truthful and complete.

I further certify that will immediately inform the Organization of any changes in circumstences that would alter my original respoinses to this Screening Disclosure Form. Failure to do so may result in the withdrawal of volunteer responsibilities or other privileges and/or disciplinary action.

I further agree to adhere to the Organization's policies and procedures, including but not limited to the Code of Conduct and Ethics, Conflict of Interest Policy, Privacy Policy and Screening Policy. The organization's policies are located at the following link: calgarylawnbowlingclub.ca/safe-sport