Eleventh Judicial Circuit Volunteer Program Application Lawson E. Thomas Courthouse 175 N.W. 1st Avenue, Room 3016 Miami, Florida 33128 Tel.: (305) 349-7000/ Fax: (305) 808-0240 Eleventh Judicial Circuit of Florida Administrative Office of the Courts Anays Lorenzo, Volunteer Coordinator 175 N.W. First Avenue, Room 3016 Miami, Florida 33128 Office: (305) 349-7000 Fax (305) 808-0240 Email: [email protected]
Volunteer Program Application
PROGRAM MISSION STATEMENT “To enable members of the community to become actively involved in their judicial branch of government while providing the public and judicial system with assistance by serving as administrative, informational, and educational liaisons between the courts and the community.”
*PLEASE CHECK THE BOX THAT APPLIES*
LAW SCHOOL STUDENT: *NOTE: Law Students must submit a Resume and Cover Letter with application for consideration.
LAW SCHOOL NAME:
OTHER:
*PLEASE PRINT CLEARLY*
First Name Middle Name Last Name
Home Address Street Address
City State Zip Code
CELL Phone HOME Phone Number WORK Phone Number
() - () - () -
11th Judicial Circuit of Florida Last Updated 9/25/2012 Page 1 of 12 Eleventh Judicial Circuit Volunteer Program Application Lawson E. Thomas Courthouse 175 N.W. 1st Avenue, Room 3016 Miami, Florida 33128 Tel.: (305) 349-7000/ Fax: (305) 808-0240 Email Address:
11th Judicial Circuit of Florida Page 1 of 9 Last Updated 9/25/2012
2 Eleventh Judicial Circuit Volunteer Program Application Lawson E. Thomas Courthouse 175 N.W. 1st Avenue, Room 3016 Miami, Florida 33128 Tel.: (305) 349-7000/ Fax: (305) 808-0240 Education
✔ IF CURRENTLY ATTENDING , High School Name City, State Years Completed
, College Name City, StateYears Completed
, Graduate School/ Law School City, State Years Completed
Employment Information
I am: Employed Not Employed
Employer’s Name
Occupation
Street Address
City State Zip Code
Personal Information
List any languages, other than English, which you speak or write fluently:
Emergency Contact: ()- Name Relationship Phone
References
Please provide two references:
Name: Phone ()-
11th Judicial Circuit of Florida Last Updated 9/25/2012 Page 3 of 12 Eleventh Judicial Circuit Volunteer Program Application Lawson E. Thomas Courthouse 175 N.W. 1st Avenue, Room 3016 Miami, Florida 33128 Tel.: (305) 349-7000/ Fax: (305) 808-0240 Name: Phone ()-
4 Eleventh Judicial Circuit Volunteer Program Application Lawson E. Thomas Courthouse 175 N.W. 1st Avenue, Room 3016 Miami, Florida 33128 Tel.: (305) 349-7000/ Fax: (305) 808-0240 Availability
Which areas of the Court are you interested in (Please choose three):
Civil Family Court Services Probate
Criminal Foreclosure Unified Family Court
Domestic Violence Juvenile Other Division
List Division
WHAT PERIOD OF TIME ARE YOU AVAILABLE?
START DATE: END DATE:
What days and hours would you be available?
MONDAY TUESDAY WEDNESDAY THURSDAY FRIDAY Start: Start: Start: Start: Start:
End: End: End: End: End:
How many total hours per week would you be available?
List any current or previous internship or volunteer service:
Briefly, please state the reason(s) you are interested in volunteering with the court system.
Acknowledgement
By means of my signature below I hereby acknowledge that any omissions, falsifications, or misrepresentations on this application may disqualify me from consideration as a Volunteer for the Eleventh Judicial Circuit. I understand that any information I provide on this application may be investigated as allowed by law. I furthermore consent to the release of all information concerning my background and competency as a volunteer, by employers, schools, law enforcement agencies, and any other individuals or organizations that may have pertinent information about me, to authorized representatives of the Eleventh Judicial Circuit. I further understand that this application is a matter of public record as allowed by law. I certify, to the best of my knowledge and belief that all statements contained herein and on any attachments and statements hereto are true, correct, without omissions, and made in good faith. I acknowledge that I will not be paid or compensated in any way for any of my services as a Volunteer.
Applicant’s Name: 11th Judicial Circuit of Florida Last Updated 9/25/2012 Page 5 of 12 Eleventh Judicial Circuit Volunteer Program Application Lawson E. Thomas Courthouse 175 N.W. 1st Avenue, Room 3016 Miami, Florida 33128 Tel.: (305) 349-7000/ Fax: (305) 808-0240 Print
Applicant’s Signature: Date: Sign
Acknowledgement of Gratuitous/Voluntary Services and Waiver
I, , hereby declare that any services I shall perform in the capacity of Volunteer for the Eleventh Judicial Circuit, Miami-Dade County, Florida, are rendered solely in voluntary capacity. I hereby waive any claim or right to receive salary or any other compensation in consideration for the performance of all duties assigned to me. I further acknowledge that I am not entitled to receive any benefits normally rendered to a paid employee, including but not limited to health insurance, retirement benefits, sick leave, or other related personnel benefits as a consequence of my voluntary service.
In the event of any personal injury incurred by me while performing services as a Volunteer, I shall have only those rights to compensation, if any, which may be provided by statute to persons rendering voluntary services to the court system of the State of Florida or to Miami-Dade County. I agree to adhere to all policies and procedures governing the conduct of business in the division where I am assigned. I recognize that information which I may obtain or may have access to in the course of my voluntary services is often of a confidential nature, and I fully agree to permanently preserve the confidentiality of such information.
By signing below I declare that I fully understand that I will not be paid or receive any benefits for my services as a Volunteer.
Applicant’s Name: Date: Print
Applicant’s Signature: Date: Sign
Witness Name: Date: Print
Witness Signature: Date: Sign
6 Eleventh Judicial Circuit Volunteer Program Application Lawson E. Thomas Courthouse 175 N.W. 1st Avenue, Room 3016 Miami, Florida 33128 Tel.: (305) 349-7000/ Fax: (305) 808-0240
11th Judicial Circuit of Florida Last Updated 9/25/2012 Page 7 of 12 Eleventh Judicial Circuit Volunteer Program Application Lawson E. Thomas Courthouse 175 N.W. 1st Avenue, Room 3016 Miami, Florida 33128 Tel.: (305) 349-7000/ Fax: (305) 808-0240 Code of Ethics for the Eleventh Judicial Circuit of Florida Volunteers
It is the policy of the Eleventh Judicial Circuit that all Volunteers shall follow the rules of conduct as stated herein, including all orders and directives, which may be issued by the Circuit.
(1) Volunteers will hold as absolutely confidential the official business of the Eleventh Judicial Circuit. Volunteers may not remove or copy official records or reports from any department of the Eleventh Judicial Circuit, except under the direct order or supervision of a member of the paid staff. Volunteers are to direct any media questions whether print or electronic to the Director of Government Liaison and Public Relations, the Court Administrator or the Chief Judge.
(2) Volunteers should conduct themselves in a manner which reflects favorably on the Eleventh Judicial Circuit and the Volunteer Program. Volunteers shall be courteous and demonstrate tolerance and respect to the public and co-workers. Volunteers shall be tactful in the performance of assigned duties, shall control their temper and exercise utmost patience and discretion, and shall not engage in argumentative discussions. While on duty, Volunteers shall not use insolent language or gestures toward the public or co-workers concerning race, sex, religion, politics, national origin, lifestyle or other similar personal characteristics.
(3) Volunteers are to maintain a professional appearance while on Volunteer service.
(4) Volunteers will not drink intoxicating beverages while on duty or use any controlled substances, narcotics or hallucinogen, except when prescribed in the treatment of a Volunteer by a licensed physician or dentist.
(5) All Volunteers are asked to be punctual and reliable.
(6) Any Volunteer unable to report for duty due to sickness or other cause shall, as soon as possible, notify their assigned supervisor or the Volunteer Coordinator.
(7) The Volunteer’s position can be terminated at the sole discretion of the Circuit as a result of (a) failure to comply with the Eleventh Judicial Circuit’s policies, rules and regulations; (b) unsatisfactory attitude, work or appearance: or (c) any other circumstances which, in the judgment of the Volunteer Coordinator, would make continued service as a Volunteer contrary to the best interests of the Volunteer Program.
We sincerely value your participation in our Volunteer Program at the Eleventh Judicial Circuit. We hope you find your time enjoyable and rewarding.
Applicant’s Name: Print
Applicant’s Signature: Date: Sign
8 Eleventh Judicial Circuit Volunteer Program Application Lawson E. Thomas Courthouse 175 N.W. 1st Avenue, Room 3016 Miami, Florida 33128 Tel.: (305) 349-7000/ Fax: (305) 808-0240
Computer and Telecommunications Use Policy for Volunteers
Within this policy, you will find a description of the policies and guidelines for use of the computer and telecommunications resources of the Eleventh Judicial Circuit. All users of such systems within the Eleventh Judicial Circuit have the responsibility to use these resources in a professional, ethical, and lawful manner. The computers and computer accounts provided to users by the Eleventh Judicial Circuit are to assist such users in the performance of their assignments. The computer and telecommunications systems belong to the Eleventh Judicial Circuit and may only be used for authorized judicial purposes.
To better serve our constituency, the Eleventh Judicial Circuit provides its users with the best tools to effectively and efficiently perform their assignments. As such, the Eleventh Judicial Circuit provides access to one or more forms of electronic media, media services, or tools/materials, including, but not limited to, computers, e-mail, copiers, telephones, televisions, VCRs, DVD players, voicemail, facsimile machines, an intranet, wire services, online services, and Internet.
The Eleventh Judicial Circuit encourages the use of these media and associated services to make communication more efficient and effective and because they are valuable information sources. Users connected with this organization, however, should remember that electronic media, media services, or tools/materials provided by the Eleventh Judicial Circuit are the property of the Eleventh Judicial Circuit and their purpose is to facilitate and support official judicial business. All users of the computer and telecommunications resources of the Eleventh Judicial Circuit are responsible for ensuring that these resources are used in a professional, ethical, and lawful manner.
A. Waiver of Privacy All computer and telecommunication users of the Eleventh Judicial Circuit waive their right of privacy in anything they create, store, send, or receive on the Eleventh Judicial Circuit’s computer and telecommunications system. All computer and telecommunication users consent to management or supervisory personnel of the Eleventh Judicial Circuit accessing and reviewing all material they as users create, store, send, or receive on the computer or telecommunications system. Users further understand that anything they create, store, send, or receive on the Eleventh Judicial Circuit’s computer and telecommunications system may constitute a judicial record per Fla. R. App. P. 2.420 to which the public may have access.
B. Prohibited Use Use of the Eleventh Judicial Circuit’s computer or telecommunications system for any of the following activities is strictly prohibited:
1. Sending, receiving, displaying, printing, or otherwise disseminating material that is fraudulent, harassing, embarrassing, sexually explicit, obscene, intimidating, or defamatory; 2. Sending, receiving, displaying, printing, or otherwise disseminating confidential, proprietary judicial information in violation of Circuit policy or proprietary agreements; 3. Transmitting, storing, or otherwise disseminating commercial or personal advertisements, solicitations, promotions, destructive programs (e.g., viruses or self-replicating code), or political material; 4. Violating any state, federal, or international law governing intellectual property (e.g., copyright, trademark, and patent laws) and online activities; and 5. Violating any license governing the use of software.
11th Judicial Circuit of Florida Last Updated 9/25/2012 Page 9 of 12 Eleventh Judicial Circuit Volunteer Program Application Lawson E. Thomas Courthouse 175 N.W. 1st Avenue, Room 3016 Miami, Florida 33128 Tel.: (305) 349-7000/ Fax: (305) 808-0240 Computer and Telecommunications Use Policy for Volunteers (Continued)
C. Personal Use The computers, electronic media and services, electronic tools/materials, and telecommunications systems provided by the Eleventh Judicial Circuit are primarily for official judicial use to assist users in the performance of their assignments. Limited, occasional, or incidental use of the computers, electronic media and services, electronic tools/materials, and telecommunications systems for personal, non-business or non-judicial business purposes is understandable and acceptable, and all such use should be done in a manner that does not negatively affect the systems’ use for their official business purposes. Users, however, are expected to demonstrate a sense of responsibility and not abuse this privilege.
D. Software and Hardware Peripherals To prevent computer viruses from being transmitted through the Eleventh Judicial Circuit’s computer system, unauthorized downloading or uploading of any unauthorized software is strictly prohibited without advanced approval from the users’ supervisor. Unauthorized software is any software that was not installed or approved by CITeS on the computer’s hard drive when it was first delivered to the end user. Only CITeS staff may install or attach software or peripherals after proper approval has been sought and obtained. All computer and telecommunication users are further restricted from attaching unauthorized peripheral hardware to their assigned computers. Users must contact CITeS for assistance with software and peripherals.
E. Violations Violations of this policy may result in the immediate termination of your Volunteer services and, if applicable, it may implicate legal action and/or criminal liability.
I have read and fully understand the Eleventh Judicial Circuit of Florida Administrative Office of the Courts Computer and Telecommunications Use Policy for Volunteers. As a user of the Eleventh Judicial Circuit of Florida Administrative Office of the Court’s computer and telecommunications system, I will abide by these rules.
Applicant’s Name: Print
Applicant’s Signature: Date: Sign
Witness Name: Print
Witness Signature: Date:
Sign
10 Eleventh Judicial Circuit Volunteer Program Application Lawson E. Thomas Courthouse 175 N.W. 1st Avenue, Room 3016 Miami, Florida 33128 Tel.: (305) 349-7000/ Fax: (305) 808-0240 Background Check Authorization
Social Security Number Date of Birth Sex Race Female Black -- Male White
*PLEASE PRINT CLEARLY*
List any misdemeanor convictions:
List any felony convictions:
Please read and sign this form in the space provided below. Your written authorization is necessary for completion of the volunteer application process.
I hereby authorize the Eleventh Judicial Circuit to investigate my background and qualifications for purposes of evaluating whether I am qualified for the volunteer position for which I am applying. I understand that the Eleventh Judicial Circuit might utilize an outside firm or firms to assist in checking such information, and I explicitly authorize such investigation by any information service and outside entity of the Eleventh Judicial Circuit’s choice. I also understand that I may withhold my permission and that in such a case, no investigation will be done, and my volunteer application will not be processed further.
I additionally authorize and request any present or former employer, school, law enforcement agency, city, state, county and federal court and agency, military service or other persons having personal knowledge about me, to furnish the Eleventh Judicial Circuit with any and all information in their possession regarding me, in connection with this application. I consent that a photocopy of this authorization be accepted with the same authority as the original, and additionally waive any written notice from any present or former school, agency, law enforcement agency, city, state, county and federal court and agency, military service or other persons having personal knowledge about me, who may provide information based upon this authorized request. I understand this authorization is part of the written volunteer application that I sign.
Applicant’s Name: Date: Print
Applicant’s Signature: Date: Sign
11th Judicial Circuit of Florida Last Updated 9/25/2012 Page 11 of 12 Eleventh Judicial Circuit Volunteer Program Application Lawson E. Thomas Courthouse 175 N.W. 1st Avenue, Room 3016 Miami, Florida 33128 Tel.: (305) 349-7000/ Fax: (305) 808-0240 Equal Opportunity Rights
The Eleventh Judicial Circuit is an equal opportunity employer and does not discriminate on the basis of race, color, gender, religion, age, national origin, disability, genetic information, ethnicity, ancestry, marital status, familial status, pregnancy, sexual orientation, military status, and veteran status or any other legally protected criteria or condition. Thus, the circuit extends these rights to volunteers who consider participating in the program. If you need an accommodation to participate in the application/selection process/program, please contact the Eleventh Judicial Circuit Court’s ADA Coordinator, Lawson E. Thomas Courthouse Center, 175 NW 1st Ave., Suite 2702, Miami, FL 33128, Telephone (305) 349-7175; TDD (305) 349-7174; Fax (305) 349-7355 ; email [email protected] with at least 7 days advance notice or as soon as feasible. If you are hearing or voice impaired, call 711.
By signing below I acknowledge receipt of disclosure of the equal opportunity rights.
Applicant’s Name: Print
Applicant’s Signature: Date: Sign
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