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Here is the text we could read:

RETURN TO:
Human Resources Division
Administrative Office of Courts
300 Dexter Avenue
Montgomery, AL 36104-3741

Application for Volunteer Services
ADMINISTRATIVE OFFICE OF COUR

www.alacourt.gov

Form PERS-23

PART I. – APPLICANT IDENTIFICATION
Social Security Number

Last Name

We Are An Equal Opportunity Employer

Cour

First Name

M.I.

Area Code

Phone Numbers

Work:

Home :

Mailing Address (Street Number / Name , Apt. Designation or RFD

City

State

Zip Code

County

Are you currently working within the Unified Judicial System?

Yes No

PART II. – INDICATE ANSWER BY PLACING AN “X” IN THE PROPER BOX

1. Have you ever been discharged or forced to resign from a position? Yes No

2. May inquiries be made of your present and/or past employers regarding character, qualifications, or work performance?

Yes No

3. Have y ou ever been convicted of a crime or violation other than a “minor” traffic offense? If yes, explain charges, where convicted and dates below.

Yes No ___________________________________________________________________________________________________
__________________________________________________________________________________________________________________

PART III. EDUCATION AND CERTIFICATIONS – Give Your Complete Educational History

Did you graduate from high school or pass the high school equivalency test? Check your answer

Yes No

LEVEL

NAME & LOCATION

From

DATES

Mo. Yr. Mo.

Yr.

YEAR of

COMPLETION

CRED.
HOURS

DID
YOU
GRAD?

DEGREE OR
DIPL. & DATE

MAJOR
SUBJECT

Elementary or
High School

College

Graduate or
Professional

Other Education,
Intern., etc.

1. List field of work for which you are licensed, registered, or certified. Give date and source of issuance.

Alabama county where I am primarily interested in working:
1. ______________________________________________

(Optional) Other Alabama counties where I will accept employment:
2. _______________________________ 3. __________________________

Items below to be completed by Human Resources

Note: A felony conviction will bar employment in law enforcement and certain judicial positions. The disclosure of a misdemeanor will not automatically result in
disqualification from employment. Criminal histories will be submitted to the National Crime Information Center (NCIC) for verification. Failure to disclose a conviction
may be considered grounds for disqualification. For these reasons, applicants should be careful to disclose ALL criminal convictions.

State of Alabama U.J.S. Form No. PERS-23 Rev.10/19

PART IV. – EMPLOYMENT – This section must be completed even if a resume is attached.

Application for Volunteer Services

Answer questions for each period of employment; include previous employment with the State of Alabama, military service, and related
volunteer work. Failure to give complete information will result in rejection of your application. Begin with your present or last position.
If more space is needed, use a continuation sheet (page 3). Providing salary information is optional.

Starting

__
A. Title of present or most recent position __________________________________________ Salary _____________Last Salary__________

ame & Title of supervisor __________________________________ No. emp. superv. by you ___________
Employer __________________________ Address _____________________________________________
Duties __________________________________________________________________________________
_______________________________________________________________________________________
_______________________________________________________________________________________
_______________________________________________________________________________________
_______________________________________________________________________________________
_______________________________________________________________________________________
Reason for leaving _______________________________________________________________________

Date employed

Date separated

Full-time

Yrs.

Mos.

Part-time

Yrs.

Mos.

If part-time, no. of hrs.
worked /wk.

Starting

B. Title of next most recent position _______________________________________________ Salary _____________Last Salary___________

Date employed

Date separated

Full-time

Yrs.

Mos.

Part-time

Yrs.

Mos.

If part-time, no. of hrs.
worked /wk.

Name & Title of supervisor __________________________________ No. emp. superv. by you ___________
Employer ______________________________ Address__________________________________________
Duties __________________________________________________________________________________
_______________________________________________________________________________________
_______________________________________________________________________________________
_______________________________________________________________________________________
_______________________________________________________________________________________
_______________________________________________________________________________________
Reason for leaving _______________________________________________________________________

Starting

C. Title of next most recent position _______________________________________________ Salary _____________Last Salary___________

Date employed

Date separated

Full-time

Yrs.

Mos.

Part-time

Yrs.

Mos.

If part-time, no. of hrs.
worked /wk.

Name & Title of supervisor __________________________________ No. emp. superv. by you ___________
Employer _____________________________ Address ___________________________________________
Duties __________________________________________________________________________________
_______________________________________________________________________________________
_______________________________________________________________________________________
_______________________________________________________________________________________
_______________________________________________________________________________________
_______________________________________________________________________________________
Reason for leaving _______________________________________________________________________

CERTIFICATION AND CONDITION OF EMPLOYMENT AGREEMENT

I certify that the statements on or attached to this application are true and correct to the best of my knowledge. I know that any
false statements may cause me to be denied employment, the chance for testing, to be removed from an employment register,
or to be released from employment. I authorize the release of all prior employment, military service, academic/school and
criminal records. If employed, I agree, consistent with applicable laws, to receive compensatory time off in lieu of overtime cash
compensation. I also certify (if applicable) that I have enclosed proof of my service registration in compliance with Act 91-584.

Date ____________________________________

Applicant’s Signature : ________________________________________________

State of Alabama U.J.S. Form No. PERS-23 Rev.10/19

EQUAL EMPLOYMENT OPPORTUNITY REPORTING AND RESEARCH

(Federal Employment Opportunity Reporting and Research requires the following Information which is not used to evaluate your
application.)

Month

Day

Year

Male Female

Yes No

Date of Birth

Sex

Social Security #

*Act 91-584 mandates that persons required to register with the U.S. Selective Service System (i.e., male citizens of the U.S.
between the ages of 18 and 26) furnish proof of registration before any offer of employment, promotion, or advancement may be
made by the State of Alabama.

A copy of the Selective Service registration must accompany this application.

U.S. Citizen

4. Black

5. Hispanic/Latino

1. White

2. Oriental/Asian
3. Native American

Yes (X) No (X)

AVAILABILITY SCHEDULE

DAY

SUN

MON

TUES WED

THUR

FRI

SAT

IVE DETAILS (use additional paper, if necessary)

HOURS: from

HOURS: to

ist additional languages

OW DID YOU LEARN ABOUT OPPORTUNITIES IN JUDICIAL VOLUNTEERING?

HY DID YOU CHOSE TO APPLY AS A JUDICIAL VOLUNTEER? (Use additional paper, if necessary)

HAT TYPE OF VOLUNTEER WORK DO YOU WISH TO PERFORM?

re you willing to make a two year

commitment?

o you have a valid Alabama driver’s

license? (optional) If yes, the
driver’s license # _________________

re you fluent in a language other

than English?

re you associated with/related to

anyone in the justice system or
anyone involved in the program you
are applying to?

ave you, or a member of your
family, been involved in juvenile
court proceedings? (optional)

S
P

E C

I
F

I C

P
R
O
G
R
A
M

I
N
F
O
R
M
A
T
I
O
N

CHARACTER REFERENCES (exclude relatives)

NAME

ADDRESS

TELEPHONE NUMBER

I, the undersigned, hereby

STATEMENT

•

•
•
•

understand that all the information requested will be for confidential use in determining my placement in the
program.
understand that I must complete all training required to maintain my position in the program, if accepted;
acknowledge that, to the best of my ability, all the information given on this form is true and correct.
authorize the Unified Judicial System to obtain a complete criminal background check (please see Release
Form).

_________________________________
APPLICANT'S SIGNATURE

_________________________
COUNTY VOLUNTEERING

____________

DATE

State of Alabama U.J.S. Form No. PERS-23 Rev.10/19

Application for Volunteer Services

This info page is part of the LIT Lab's Form Explorer project. It is not associated with the Alabama state courts. To learn more about the project, check out our about page.

Downloads: You can download both the original form (last checked 2023-03) and the machine-processed form with normalized data fields.

About This Form:

Sourced from eforms.alacourt.gov (2023-03)
Page(s): 3
Fields(s): 312
Average fields per page: 104
Reading Level: Grade 10
LIST Grouping(s): GO-00-00-00-00.

Use our Rate My PDF tool to learn more. Go beyond the above insights and learn more about this or any pdf form at RateMyPDF.com, includes: counts of difficult words used, passive voice decetion, and suggestions for how to make the form more usable.

Identified Data Fields:

We have done our best to automaticly identify and name form fields according to our naming conventions. When possible, we've used names tied to our question library. See e.g., user1_name. If we think we've found a match to a question in our library, it is highlighted in green. Novel names are auto generated. So, you will probably need to edit some of them if you're trying to stick to the convention.

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text__279 was Text44.1 (0.35 conf)
text__280 was Text44.2 (0.35 conf)
text__281 was Text45 (0.35 conf)
text__282 was Text46 (0.35 conf)
check_box__20 was Check Box47.0.0 (0.37 conf)
check_box__21 was Check Box47.0.1 (0.37 conf)
check_box__22 was Check Box47.1.0 (0.37 conf)
check_box__23 was Check Box47.1.1 (0.37 conf)
check_box__24 was Check Box47.2.0 (0.37 conf)
check_box__25 was Check Box47.2.1 (0.37 conf)
check_box__26 was Check Box47.3.0 (0.37 conf)
check_box__27 was Check Box47.3.1 (0.37 conf)
check_box__28 was Check Box47.4.0 (0.37 conf)
check_box__29 was Check Box47.4.1 (0.37 conf)
text__283 was Text48 (0.35 conf)

We've done our best to group similar variables togther to avoid overwhelming the user.

Suggested Screen 0:

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