ࡱ> (*'  bjbjUqUq "77l 2TVVVVVV$ 'zz TT:,T '*M9  T0RTEmployee/Volunteer Disclosure Statement ________________________________________________________________ First Name Middle Initial Last Name ________________________________________________________________ Social Security Number ________________________________________________________________ Street Address Town State and Zip Code ________________________________________________________________ Drivers License Number State Expiration Date 1. Background in Youth Sports: Position(s) Date(s) __________________________________________________________ __________________________________________________________ __________________________________________________________ __________________________________________________________ 2. Previous Residence(s) for the last 5 years: __________________________________________________________ __________________________________________________________ __________________________________________________________ __________________________________________________________ 3. Have you ever been convicted of a crime? If yes, please explain: ________________________________________________________________ By signing this application, I hereby verify that the information provided is true and correct. ________________________________________________________________ Signature Printed Name Date ( OJQJ^J56CJOJQJ\]^J()*k6bcST   ;?$a$ ?{|234yz  ^  1h/ =!"#$% i8@8 NormalCJ_HaJmH sH tH <A@< Default Paragraph Font<>< Title$a$56OJQJ\]^J()*k6bcST   ;?{|234yz^000000000000000000000000000@000000000000000000 ?  ()*kwx6FGMOTVcGRTCarolineeC:\Documents and Settings\Caroline\Application Data\Microsoft\Word\AutoRecovery save of Document1.asdCarolinebC:\Documents and Settings\Caroline\My Documents\Herndon Lacrosse\NVYLLWC\2005\SafeKids Program.docCaroline{C:\Documents and Settings\Caroline\My Documents\Herndon Lacrosse\NVYLLWC\2005\Mandatory Coaches Meeting\SafeKidsProgram.docCaroline{C:\Documents and Settings\Caroline\My Documents\Herndon Lacrosse\NVYLLWC\2005\Mandatory Coaches Meeting\SafeKidsProgram.docCaroline{C:\Documents and Settings\Caroline\My Documents\Herndon Lacrosse\NVYLLWC\2005\Mandatory Coaches Meeting\SafeKidsProgram.docCarolineC:\Documents and Settings\Caroline\My Documents\Herndon Lacrosse\NVYLLWC\2005\2005NVYLLWCMandatoryCoachesForms\EmployeeVolunteerDisclosure.docCarolineC:\Documents and Settings\Caroline\My Documents\Herndon Lacrosse\NVYLLWC\2005\2005NVYLLWCMandatoryCoachesForms\EmployeeVolunteerDisclosure.docCarolineC:\Documents and Settings\Caroline\My Documents\Herndon Lacrosse\NVYLLWC\2005\2005NVYLLWCMandatoryCoachesForms\EmployeeVolunteerDisclosure.docOppenheimer & Co.*H:\Desktop\EmployeeVolunteerDisclosure.doc fEii`-3h ^`OJQJo(h ^`OJQJo(oh pp^p`OJQJo(h @ @ ^@ `OJQJo(h ^`OJQJo(oh ^`OJQJo(h ^`OJQJo(h ^`OJQJo(oh PP^P`OJQJo(h ^`OJQJo(h ^`OJQJo(oh pp^p`OJQJo(h @ @ ^@ `OJQJo(h ^`OJQJo(oh ^`OJQJo(h ^`OJQJo(h ^`OJQJo(oh PP^P`OJQJo( ii`                  @Od`@UnknownGz Times New Roman5Symbol3& z Arial?5 z Courier New;Wingdings"hR¢R¢ !r02Q'Employee/Volunteer Disclosure StatementOppenheimer & Co.Oppenheimer & Co.Oh+'0 8D ` l x(Employee/Volunteer Disclosure StatementmplOppenheimer & Co. Dppeppe Normal.dot Oppenheimer & Co. D2peMicrosoft Word 9.0D@@\M9@\M9՜.+,0 hp|  y  (Employee/Volunteer Disclosure Statement Title  !"#$%&)Root Entry FP,*M9+1Table WordDocument"SummaryInformation(DocumentSummaryInformation8CompObjjObjectPoolP,*M9P,*M9  FMicrosoft Word Document MSWordDocWord.Document.89q