Volunteer Program Application

First Name:

Middle Name:

Last Name:

Phone:

Email:

Street Address:

State:

Zip Code:

Emergency Contact Name:

Emergency Phone Number:

What days and hours would you be available?

Please list any current or previous experience that may be beneficial in the performace of the volunteer position with the State Courts of the Twentieth Judicial Circuit:

Have you ever been convicted of or had a withhold of conviction for a Misdemeanor or a Felony?

Yes

If yes, when and what charge?

I hereby certify that the information set forth in the above application is true and correct to the best of my lnowledge. I understand that a background check must be completed prior to becoming a volunteer and that completion of this application does not guarantee my becoming a volunteer with the 20th Judicial Circuit.