Volunteer Background Check Form
A criminal background check is required on all volunteers. In order to do so, please provide us with the following information. If you have any questions regarding the Volunteer Background Check process, please contact Sara Miedema at smiedema@hpseagles.net. Thank you for volunteering in the Hudsonville Public School District.
Building
(choose all that apply)
Required
Student's Name(s): First and Last Name
(please indicate "N/A" if student name is not applicable)
Your answer
Relationship to Student
Required
Have you ever pled guilty, or been convicted of a misdemeanor in a state or federal court?
Nature of conviction, date and district court information
Your answer
Have you ever pled guilty, or been convicted of a felony in a state or federal court?
Nature of conviction, date and district court information
Your answer
Are you the subject of a current criminal investigation or have pending charges against you?
Nature of conviction, date and district court information
Your answer
Volunteer Last Name
Your answer
Volunteer First Name and Middle Name
Your answer
Maiden/Other Names
Your answer
Ethnic Background
Sex
Date of Birth
(MM/DD/YYYY)
Your answer
Phone Number
(XXX-XXX-XXXX)
Your answer
Address
Street Address, City, Zip
Your answer
Driver's License # (Optional)
Your answer
Authorization to Perform Background Check
Required
Signature
Your answer
Date
Your answer
Submit
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