ffiDWILT ffiPWLTffiffiTIl’N This application is also available in Spanish. Esta solicitud tanrbit4n estii disponible en espaiiot. nnlsstoN The nrission of the BSA is to prepare yolrng people to make ethical and moral choices over their lifetimes by instilling in thenr the values of the Scout Oath and Scout Law. b6e6rfl6b-etr6flEitffi YoTffiaft ieiBat i6tr iilh6-B sA-eatrh-d FT6nt tT I Adult leaders serve as important role models for youflr in the BSA and this application aids the chartered organization in selecting qualified adult volunteer leaders” YOUTH PROTECTION TRAINING GRIM INAL B,ACKGROUN D CI{ECK* All adult applicants are required to take ln order to complete the adult application this training in order to complete tlre adult process, you will need to review the differ- application process. Go to my.scouting.org ent disclosures that have been separately to create an account and take the train- provided to you. The separate authorization ilrg online, or contact your local council for form must be signed and returned when -
classroonr training. lnclucle a copy of your you subnrit your.application, conrpletion certificate with this application” EXCERPT FROM THE DECLARATION OF RELIGIOUS PRINCIPLE Ihe BS4 maintains that no member can grow into the best kind of citizen without recognizirtg an obligation to God and, therefore, recognizes the religious element in the training of the ntember, but it is abso/ute ly nonsectarian in ifs aftifude towarcl th ‘ at religious training. lts policy is that the home and organization or group with wttich the memberis connecf ed shalt give definite attention to religious life. Anly persons willing to subscnbe fo fhese precepfs from the Declaration of Religious Principle and the Bylaws of the BSA sha// be entif/ed lo register. All adult leaders agree to comply with the Scouter eode of Gonduct. https://wwiv”scouti ri g.org/health -and-safeVguideli nes-por iciesl *The three different background check forms must be torn off and each separately given to the applicant. sr(u 655528 BOY SCOUTS OF AMERICA ilil]Jlr$||l!ll|]|Iuilil 524-501 2023 Printing

Leader Requirenents What ls the BSA Program? ‘l”he llSA is open to all who rneet the requirements, and leaders ate selectec The BSA program is outlirred ‘n the of f icial publications oi the BSA. Activlties based on indivicjual mer;i. Aoult leaders rnust possess the moral, eduoational, tnat are not rn these BSA plblications are not a parl oi the Scouting prograir. and enrotional qualities lhat the BSA deerns necessary for positive leadership Leaders must not allovr youth meilbers 0r prograjx particiuanis to enqage in to youth. They niust also: any unauihorized or prohibited acilvities. . Abide by the Scout 0ath, Scout Law, and Scoutef Code of Conduct. The Scouter Code of Conduct can be found at www,sccuting,orqlhealth-aruL, Training for New Leaders safeftlss$lbsa:sr.a$qrusle:[f-e-ud!-aV. Tne BSA is conmitted to your success as a volunteer whrle servrng yorrng ‘ Subsc:ibe to the precepis of the Declaration of Religiols Principle, people. ro help y0u be successful, there are iraining materials designerl “ Reside within the USA or a U.S. territory, or be a U.S. citizen residin.cl for you,Training resources are available tl.rough your local coLritcil antl at . olrtsid€ the LISA. m\t.scoutinq-“019, Be 21 years 0{ age or older for primary leadership positions. . Be 18 years of age or older for assistant leadership positi0ns, What Makes a Trained Leader? r Cotnplete Youth Protection training (YPT) liefore application is processed v,ou are consjdered a tralned leader when you have conrpleted leacier posii:on- and renew training as required hy going to my.scouting.org ano creating specilic training foryour position and have currentYouth prolection iralning. an account. _ ._Bejtgqllg diqQlsgluQulgr]Iation relqt!! !!-j!g_9’S45!_4sliSrg!l!lr]-A!_e![– Youlh Protoction Begin$ With YourM process and complele and sign a Bacltgroirnd CheckALrthorization form. Chlld abuse ls aseilous problom in’0urs00lety, and unlortflnately,-i: can-occ[r,— . Take leader posilion-specjfic training at my.scoutitlg.Qra. Classroom anytl,rhere, even in Scoutinq. For that reason, the BSA conlinues io creaie tralning rnay also be availa0le through your local council. barriers to abuse beyond rrrrhat have previously existed in Scou:lng, It is the philosophy of Scouting to welcone all eligible adults, The BSA is commitled to providing a safe enviroilnent for youlrq pecple. regardless of gender, race, ethnic background, sexual orienlation, All adult leaders niust conrplete Youth Proteciion lrain ng as oari 0f the or gender identilication, who are willing l0 accept Scouting’s values regisrration process and ren0!v their iraining as requirecl, lt is highly and meel any other requiremenls of membership, reconrmended that parents who parlicipate in Scouting activities complete YPT. To learn nrore about the BSAs Youth Proler;ilcr resources, go to APPROVAT REQU lRED–.IJ N IT ADULTS viv/v,’.$c_Q,uti n g,0rg/traili[g&O_Uth:plo-t_e_cti 0n/. The charlered organization representative is approved by the head of the chaileterl oi’ganization. All other adult leader applications must be accepted Mhndatory Reporting and approved hy the head of the chartered organization 0r the chaner€ri Allpersons involved in Scouting niust imnreriiately repot io local autnorilies organization representative, any good{aith su.spicion 0r belief that any child is or ha.s been physically or sexually abused; physiually or entotionally neglecter{; exposed to any form Scout executive or designee nrust approve any aclults r,vho answer “yes” to 0f viOlence or threat; or exposed to any forrn of sexual explOitation includlnc any Addilional lnformation question. the possession, rnanufacture, or distributlon of chik\gornograohy, nnlire .solicitation, entice ntcnt, or showing of obscene mateilal. No person may APPR0VAI R EOUIRED-*COUNCII and DISTRICT ADULTS abdicate this repoding responsibility to any other person. Scout executive or designee must acceDt and appr0ve all council anrl distr’lct atiults. Acldilionally. any known or suspected abuse or behavior that might put a youth at risk must also be repofied to ihe lucal ScoL[ execLrtive or the Sccull; Scout executive or dosignee nust apptove any adulls lvho answer “yes” lo First Helpline (1 -844-SC0UTS1 ar 1-844-726-887t) lf ycur Scolt execui ve ur any Adriitional lnlOrmati0n ousstion. local council cannot be reached. The adult lea{ler applicalion process will not be comptete unlil Youth Youth Proteclion Policies Protection training has been completed and a criminal background “ Trivo registered aoult leaders 21 years of age 0r over are reouired ai all check has beelbbtained, Scouting activities, jnclucling nreetings, There nrust be a registerecl female adult leader over 2l in every unlt serving {emales. A re gisteretl lemale arjult Health information, You sn0uld infOrm your unit leaclership of any conCition leade r over 21 rrrust be present fnr any activi[r lnvolving fenalc youtit. that night limit your participation. Bolore participaling in activlties with your “ One-on-one contact between adult leaders ancl yortth mcmbers is unit, please fill onttheAnnual Health and Medical ReDord, N0.680-001, found prohibiled bolh inside and outsicie of Scouling. 0’r WW!!.FCeUlLg.![r/forn]S arrd providc it to your uriir lcadership. Tnesc and other key Youth Protection policies are addressecl in lhe traininq Scout Life. Registered aciutts get a special $1 5 rate, For a srroscription to and at wJiily.s:qouti nq. 0glt-iarlrLli/u-01lr:proleslc.V. a magazine that helps chiloren grow in the Scouting progranr, just fill in the Sclut l”ife circle on the application and pay the subscription price. To learn about the BSA’s other health and safety policies, please review the online version ofthe Galrie to Safe Scoutiitg, the Scoulci THE ANNUAL NATIONAT REGISTBATION FEE IS NONRETUNDABLE, Code of Conduct, and the SAFE Checklist, yvhich are availabte ai wmry.$couting.org/l]ea|th-and-sate

  • BSA Privacy Potioy The BSA protects’the confidentiality of the names and personal information of Scout 0ath ihose who are afflliated with the organization, No conmercial oi-unaulhcrizecl 0n niy honor lwill do nry best to do my dLity to tiod and my country use is made of the nantes, addresses, and other confidential inlormation. and to obey the Scorfi Law; to help other ps0ple at all times: The tsSAand its affinity grcr.lps luay use regislratlon infonrration tcr notify to keep myself physically strong, mentally arlrake, arrd morally stra gilt. registrants of benefit opporlunities. Sc’out Law For general questions, contact y0ur BSA local council A Scout is trustrarodhy, loyal, helplul, friondly, coufteous, ki:rl, or visit w-wwscouting.qlq for current policies. obedient, cheerful, thrifty, brave, clean, and reverent.

BSA ADULT APPLICATION A I felds must be completed in order lo process yo,rr.eg stration, Fifst na’re (Full lbgal namo) [,] ddle name Last name Srffix ichael ames utre CoJrny llome Adc:ess Da:e of Binn {mmiddlyyn”) F^l il/El/[r,ir__l 173 Lawosn Lake Rd City MStale zlp FSocial S’oc:urilty N umibelr (r equirod) -| F-‘ eura Bush F,6’-__-] E pr tl i r fr ri a c ‘ b y a r c h kE 0 ro 1 un e c: (f BlaolvAfricar e CaLcasian/Whlte CNatlveAnte p rlc h ar o f: n H € lspantc/t-attno C.AlaskaNaflve Qpacificlslandcr OAsian COther Gerder: 6 M CF Alternaie Extension foJ–rtt,fr I I subsctiption I PlsaBe sgleci your prelererce cf comntlnlcatlon: O Emall (^r Phone Call Fr SMS/T€ht 0ccupation e4y Ema I address [qgui f - e29 * @g : m E ai l.q,q1 7 1 n7F :’ reqtal-ql_BgalE rq p Are !.’oir ar Eagle Scout? Yes €, t’to C, f sr, enter cjate eanled Eagle (ntnvdilyltry) EinfJloyer y County, Albany NY All questions MUST be answsred. Writo N0NE il n0t applicable. 3. PIev 0us residences (i0r las: i0 yeafs). il, ljav€ you evor boon arresled l0r a crimi’]al ofl€ns€ Yes llo

  1. Scoutin0beckUrourd, CITY (otherlhan nin0rtrafllc volatlons)? Explaln: {-‘{i ‘tstTtll1 colNctr I h.vE beeidr mT.wrenlre6dneie Lr or€r.0./es6
  2. Cuffent memL\erships (rel gious, community, business, labor,0r c, Has your drjvgr s llcense ever beer suspended cr Y e es C N I o ExcriI {.ilc0 vrorking lrJ th yollth ir 0lher 0tgan zatiors. n l r \ o fe Y ss S o n A ai o s r s ga e ni s za s iio o ns r ) s . Association revoked? Expla n Pltras. prOvl0e ccntact in’0imatl0n l0r at least two below. O’Eanizatiof _i: lo:Yo,b NYS AsE..{1.1 olCounly Dr€.Ors ol(oa P.ciet/fa/ S6.7res coltac: nane c.rn.81!a r:i!L,rl ?hoi: ‘t””’’ ‘ - Add li01al informallon. (lvlarJ(‘each answer.) d, F o a r v c e h a y i o g u e d s v rr o i ‘ t b t €o a r b r use n v o o . s t n ig e a g t l o e d c t fo cf r , a a c r o u lo s€d r ch 0 i f l , i? Y q e -; s , N g c l 0-,f aniZatiOn F rlt.ioli!- e lerh crn*.[nr6!r a. -lave you elor been removed from 0: esked l0 leave a C Yes C N I o Explain: ccn,?^+ nane !r.n ‘.’ic’ l : 0 e a g 0 a e id r i s n h .i p y p o o u s r i t p io e n r s i c r n a a r l C 0r 0 u n a d n u c z t a 0 tio : n b e d : L ‘re e v t0 0 l a ? l le E g x a p t l i a O in ns [)ltc l, 0’oaIlzrthtl Clrr:aot rarre Phcre I lalL”bi c.rl:J lil:t INIIIALS l. I ira’E lrra( arid aflj r. tha: I acc0:1 J10 Darlariilcr ct F0l0lni.s P.hc pls. I agres l0 c0mply l,irtth ,’n rhs Irles a.ii .eEJlallans cl tfe 3SA anr the lncal mr.nc t, nilrdlrrg il.e Scolter CodB c. gtrrluci ,.42.
  3. I i:iiin :ril lle i1’cr-atif1 cor:a fel in lhis apll cll]ot is true an( licurNte to lhe besl cf my ,illv,l€l!,i aiN b€l e:. m aerl:;ica:€ allrch€d afl Backg”iunC iieck ALllhcrlzat cn lcm TO BE COMPLETED BY UNIT All appltcatiuls stt0uid be subfiliiled t0 the local council within S busxiesi days. f :t i c le D ii : r li : A j! :S a l n C V i l c U ll, l ) , t ll r u A i D l U in L- q IS ir r I I r r s q a n ve e :e ‘e s v J ll a w “ e y d t 0 i t i r i s g a a n l p ls l f r l c e a d l ic li n a l a . n il d re t h a 3 F |] t l s s e p a 0 n l l t s p o 0 s s s t0 is s a e ny s q tl u te e s n tl t o r :s tl n n n d s ! y c i a e i r e 0 d f a ‘ t Y , e a s | , d “ ard - A f6 P c P €cs R a 0 T T y ‘ A- t t 0 0 b l e C sa 0 d ll s l, f l c e lL d A :la N0 i t D lr I f S a T ; n p 1 l 6 T fa A f D t L t D T o S s i se I s s h ! a s v e ll l r e e r n ie )0 w ra e l d , e th (l d s c a a l p p o l n ic a a l t , ? o n ir d a - x o d T t h 0 a l’J v n e a l m q a r d a € L !l a ie lr s y . l c D l l b o e lv i - f i, p a d ]rq rl J i I ei leailer ii :le 8SA. orqafiza:0n iledd 0r r€p,esentative 0r cOLnc I iepresentatjve S gnatur€ 0f Scori lx€cuUyB 0t doslgnes Df.tB {) ffPact Iioop O crew tr) Shtp lf applicant has a cLrnent regishation in another unit or locat courcil, the registraiicn may be Q lrJev,i le atler O Former leader O P0sition charge fl) Pa(icipart c0mpleted at no charge by transferrlng the regls’lration 0r rnuitlple reglstering. ?^”k )z)> []n t lio. or J strict name Unit No.or Distrct nene CWrleJ Ocs\ D’p iScol.r:ilng $Position C0dB Scoutingl Polsitqion Titl-e l Trarsferring tron UilV0ounc l: PAID: at Cash $ Transl.:rapplication f. lvlultrloappllcaticn O pact< O tloop O Crew G Ship fl Check No. ccttncilrse scoutLire’ee n Enter meDrbeiship nuntter Credit card fr’om un€xpir€d reglstral oil: :lt,li’-‘“ree

Teur offthe following pages and provide to applicant separotely. A consumer repott is a background check in which information (which may include, but is not limitecl to, crirni. nal background, driving background, character, general reputation, personal characterisrics, and rnode of living) about you is gathered ancl communicated by a consumet reporting agency (.CRlt’’) to Boy Scouts of America anJ,/ or its subsidiaries, affiliates, other related entities, andr/or successors (the “Company”). The Company may obtain a consumer repoft on you to be used for ernployment purposes (in your case, this means for the purpose of evaluating you as a new or existing volunteer).

CALIFORNIA STATE LAW DISCLOSURES (Non”Credit) Urrcler Califc,rr-ria law, :ru “investigative consuner’l’eport” is a consurner leporr in rvhich infbrmation on a conslllt”Icr’s character, geucral replltation, personal characteristics, or mocle of lii,ing is obtainecl through anlt neans. Boy Scouts of America and,/or its subsicliaries, affiiiates, other related enrities, and,/or.sr.rccessors (the “Compatry”) n-ray obtain an investigati.ve consurTrer report (which may include information clescribed above) fi’onl an investigativc consumer reporting agencv (“ICRA”) on you in conncctior-r with )rout. strltlis as il volituteer (1.e., for employmenr pLrl’poses under California lnou). the natlrre and scope of this invesrigation incLudcs your ciraracter, gcneral reputation. personal characteristics, or noc]e of living in{brmariorr, including crirninal hislory and driving-record. ThC’ I CRA p:rcp:aiing ttib ihr.’d5lifatir’€-ffins1i’m€i’‘-T€lifffl’antTdirdfCrinE-The trtrFttig6-t1o-ri-rvill be First Advirtltage, P.O. Box 105292, Atlanra, GA 30348, 800,845-6004. Informarion regarding First Advantage’s ptir,acy praciices can be fbr-rnd ar htrps://faclv,corn/privacy,policp/. Under Crilitr-rrnia Civil Code scctiol) 1786.72, yoll are entitled to a visual inspection of tiles maini.ainecl on }’ou lry an ICRA, as follows: (1) In person, if you appear in person ancl furnish proper identification, c{uting normal business hour.s and on reasonable notice. A copy of your file shall also be available to you for a f’ee nor to exceed rhe .’ actlral cost.c of cluplication sen,ices provided; (2) IIV certified mail, if you make ir r.vriften reqlrest, rvitl-L plope r idcntificarion, for copies to be senr 16 a specified aclclressee. An ICRA complying with recluests for certified rntrilings trncler=California Civil ‘ Cocle seclior’. 1786,77 shall ncrt be liab[e for clisclosnres to tlrirtl palties causerl by rnishandlir-ig of rnail after sr-rch maulings leave rhe ICRA; (3) A .sLImnlaty of ,’rlL information cor-rtainecl in yotir iiles atrrl recpriled to be proviclecl lry the Califcrrnia Clivil Cocle section 17E6.10 shall be plovicled to yoLr by telephone, if ),ou have made a written Leqtlest, wjth proper icientification ibr telephone drsclosure, and the toll clrarge.s, if an1,, for the tc.lephone t:trlI are prepaiC by i’ou or cl-rerrgerl directly to yoLr. “Pt’oper Icleltification” ils ttsed abovel lnearrs i.nfbrnration generaily cleemed sufficicnt to itlerrtifi, you, r,vhich iucluclcs clocumeuts such trs a valid ch’iver’’s license, social sccurity numl-,er, military iclentificatiop ctrrcl, tllcl credit carcls. Only if yon cannot identify yourseli:rvith such inltxmation may the ICIRA recluire additional informatiott t:oncerning your e mployment and persc;nal or farnily hlstorv in orcler to verify your iclentity, Thc’lClRA u.ill plor,ic{e trainetl pelsonnel to .*pl^in eny infonlation fr-rrnishecl ro you lrllrsLrant ro Calitornia Civil Cocle scction 1786.1C and rvill prcvicle a u’ritterr explanation of arry codcd irrfbrmation conrainecl in filcs rn:rintainecl on ycir-r. This u,ritten explanation will be provided u,henever a fite is plovided to yorl for visual insps6lion under Califcrlnia Civil Code sectiorl 1786.2?”. You may be accoml”,anied by onc otlrer Lrer’.solt of your choosing, u,ho rnust furnish reasonable identification. An ICRAlnay recluire you to firrnish a written starefir.ent granting pennission to rhc ICRA to cliscuss your filc iLr such perst’l-r’s lrre.serlce,

Aclditional D isclosures Tlrc state disclostu’es below sre includetl because state law requires them to be provided in x,ritittg, Saue o.l’the below rights, notices, or infornrutiort clso utctlt ttpllly to indivitlueis ft’on4 upplyirzg lo, or voluuteering in stutes not listecl below. Tlrcre ntay he qdditionul requirements, opliotrs, or provisiorts applicttble to you nntl you. ilte! llovet additional rights rtncler applicrble lav thnt ure nol required to he disclosed to you in nriting. Nlinnesota: Yott have the right to rec1uest a corrtplete ancl accurate disclostire of the naltn’e and scope ol any consumer repolt liom Ffu’st Advantage, PO. Box 1,05292, Atlanta, GA 30348, 800,845-6004. Nerv York: Bov Scouts of Anedca ancl/or its sr.rbsidiaries, affiliates, other related entities, and/or successors (the “Company’;) rnay request or utiljze subseqttent consultter reports (othel than investigative consLrl’ner repolts) on yoit lhrorrghout your. volttnteer relationship r.vith tite Company. Upou recluest, yon rvill be infbmrec’l lvhether or not a consumer repolt was reqnesti.rl, and if sticlt’i€pot1-w?i roqilesied, infortned of thb iidine arid acldr€s.s of th-e CRA ilift friinishcd thdr’eiiiJit. Yoili writien req’uulSt ^ shoul!ber44d toBgyScpqqofAq4gryca,Nle4be4lrlp_$tandarclsTeamS201, 1325WcstWahlrtllillLane,P.O.Box-152079. Irt’ing, TX 75015-2079, \bu rnay aiso contact the Company by email at MernbershipStandards@scouting.org AUTH()RTZATI-o.A, (Please print) James McGuire Vialt4 Name: First \4idcile ;or1 SLrfrrx List any other names usecl (nickname. rnaidenirnarried last names: Ul* Date of Bir1h. 05128/2023 Unil Type and Numbe1: Cub Scout Pack 1232 ‘Ib the exlent penrritled by applicable [ar,v. I hereby conseut to and authorize the Boy Scouts olAnerica ancl/or its subsicliaries, alfiliates, other relatecl entities. ancl/or successors (the “Company”) to procLrre consunler report(i-) (as clefineci by lbdelal Iaw) anclior investigatir,e consumerreport(s) (as clefinecl bv applicable Californta state laiv). u’hich in my cas€ means crimittal background check(s)idriving recold(s), on my backgroturd fi’om a conslllnct rcpoltilg agcncy (“ClL,") or llom au iuvestigaiivc’ consuther reporling agenoy (“IClRr"). as describcd in the Bncl<grouncl Check Disclosure antl the California State Larv Disclosures (Non-Credit) (cacir of which I have’receive d separately fi’om the Company), as weil as thcs.J Additional Disclosures & Background ChechAuthorization. This aLrthorization appfies onty to cri;ninal checksiclriving recortls and cloes not allolv the Company to oblaitt cledit checks. I have revieu’ed ancl ,.rnrlerstalcl t|e infolnation. statemertrs, and notices in tire Bachgrountl Checl< Disclosure and the california state La.w Disclosures (Non,credit). as rvr-ll as rhesc Atltlitional Disclosures & Background ChcckAuthorization. N{y authorization lentains valid thloughor-:I my voluntec; reiationship rvith the Company. sncir that. to the extellt pemrittcd oy applicabie lau,. I agree thc Cornpanl’ cau pl.ocr”lrc relationship rvithout providing addltional di.sclosures ol obtainirg additional authorizations. Except as othelwise prolribitecl by applicable lalv, I consettl to anrl authorize the Cornpirny to sirare this jnfbrrlation u,ith the Company’s local councils ancVor chatlerecl otganizations 1br business r€asons (e.g,, 1o place me in celtain positions, work sites, etc.). I understand thai. if I am selected for a rroluuteer position, a consruner lcport i.r’ill havc been conducted on Dle. J For California, N nesota, or Oklahoma individuals: If you ‘,i,orLld likc to leceive lront the CR,,. thc ICR,\, or the Company (as a e Company nla)/ llrocru’e, please check this box. 09/19/2023 Signature Dut_

Original PDF: Pack1232 Michael McGuire Adult Application.pdf

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