Chapter Director Application

Your Name
Email
Address
Address
City
State
Zip
Primary Phone
Secondary Phone
Sex MaleFemale
Chapter Name
Position
List of previous youth recreation leadership experience:
Additional Comments
PREREQUISITE FOR CHAPTER PERSONNEL: It is forbidden to use profanity, alchohol, or non-prescription drugs during regular league games, practice sessions, or during league activities which include the attendance of the one or more NJB participant(s). Please understand that this organization is a nonprofit group. It is important that this form be completed in a truthful and accurate fashion. You are certifying the completeness and truthfulness of this information. Forms which are not completed may be rejected. Please read this form and, as appropriate, initial where provided.

For valuable consideration through participation in, or for, the NJB program: I hereby irrevocably consent to, and authorize the reproduction by National Headquarters, or anyone authorized by them, or any and all photographs of me by any photo medium, including video tape for normal program purposes for the current year.

I will comply with the administrative rules and regulations of this NJB Chapter as well as those of National Headquarters for the current year. I understand that this appointment is for the duration of the current season unless revoked sooner by the local board of directors or by the national headquarters.

I understand that I may be subject to a background investigation that includes, without limitation, fingerprinting and submission of my information to the Department of Justice for evaluation. By submitting this application, I am consenting to such background check; the evaluation and discussion by the appropriate individuals within the National Headquarters and responsible NJB Chapter of any information that is disclosed thereby; and the notifications required by the California penal code section 11105.3 (or equivalent penal code in your state).

I understand that NJB has a "zero tolerance" policy with respect to felony convictions for any offenses disclosed by the Department of Justice records search under California Penal Code Section 11105.3 (or equivalent penal code in your state), including similar offenses under different statutes in other jurisdictions. The National Organization has the right to reject an application or revoke privileges for any applicant for offenses disclosed by the Department of Justice records search without regard to mitigating circumstances.

I understand that if it is determined that nay of the information that I submit on this application is materially false, inaccurate or misleading, my application may be rejected and/or my privileges immediately revoked.

I certify that the information I have provided on this form is complete, true and correct.

Initials