Longview Boys Baseball Association
Longview, Texas

Full Legal Name:

Date of Birth:

Other Names (maiden, alias, etc):


Last 4 of Social Security Number:

Drivers License Number: Drivers License State: Expires:

Phone Number: Work Number: Cell Number:
(Example; 9037591111)

Home Address: List all for past 7 years

Current Address (Inc Dates resided):(Address; City, State, Zip, From-To):

Previous (including dates):

Previous (including dates):

Contact Email:


What position are you applying for?:

Have you ever been convicted of a crime? (if yes, explain)

Have you ever been refused participation in any other youth sports program (if yes, explain)

Do you have children in the program?

Why do you want to be a volunteer?

Why are you qualified to coach, manage, etc:

Acknowledgement Of Training

I acknowledge that I read the Longview Boys Baseball Association’s Simplified Child Abuse/Molestation Risk Management Program and I have carefully reviewed it and voluntarily agree that as a condition of future participation, employment or involvement in this organization, I will abide by all the terms, conditions, policies and procedures contained within this program.

If I violate the policies, regulations or spirit of this program, I will indemnify and hold harmless the Longview Boys Baseball Association, its employees, board members, volunteers and officials from any and all liability including negligence and any intentional tort claims.


I authorize and give consent for theLongview Boys Baseball Associationto obtain my personal information.

This includes, but is not limited to employment records/employer’s references; criminal background checks/fingerprints; driving record check, financial bankruptcy information, coaching experience, personal references and addresses.

I authorize this information to be obtained either in writing, via internet or via telephone in connection with my volunteer application.

I understand that my position is contingent upon adverse information about my background or character not being uncovered upon the performance of the above referenced checks. I also understand that regardless of my prior volunteer activities on behalf of the Longview Boys Baseball Association is not required to allow my continued participation.

I agree to hold harmless and indemnify from liability the Longview Boys Baseball Association and its directors, officers, employees and volunteers from all liability arising out of the use of the information that is uncovered in the above referenced checks.

For security reasons, we do not ask for your full Social Security number online. Your full Social Security number will be required. An LBBA representative will contact you to discuss your application and will ask you for the remainder of your Social Security

number so a background check can be completed.

Electronic Signature (Last 4 digits of SS#) Date: