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2019-2020 Volunteer Criminal History Record Check
PLEASE COMPLETE THIS FORM ONLY ONCE PER SCHOOL YEAR. (FAVOR DE COMPLETAR ESTA FORMA SOLAMENTE UNA VEZ POR AÑO ESCOLAR.) Applicants will NOT be notified unless a criminal history is indicated when the background check is completed. Applicants may check with the campus office to determine if their participation has been cleared/approved. Please allow one week for processing. (No se les notificará a los postulantes a menos que se encuentre que tienen antecedentes penales cuando se realice una revisión de su historial. Los postulantes pueden verificar si han sido autorizados o aprobados para ser voluntarios con la oficina de la escuela. Favor de esperar una semana para que se realice la tramitación).
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* Indicates required question
Volunteer Legal Last Name (Apellido legal de voluntario)
*
Your answer
Volunteer Legal First Name (Primer nombre legal de voluntario)
*
Your answer
Volunteer Legal Middle Name (Segundo nombre legal de voluntario)
*
Your answer
Maiden Name or Other Known By (Appellido de soltera u otros nombres por los que se conoce)
Your answer
Date of Birth (Fecha de nacimiento)
*
Month/Day/Year
MM
/
DD
/
YYYY
Ethnicity (origen etnico)
*
A=Asian, B=Black/African American, H=Hispanic/Latino, N=Native American, W=White
A
B
H
N
W
Gender (Genero)
*
Male
Female
Contact Number (Numero telefonico de contacto)
*
xxx-xxx-xxxx
Your answer
Current Address (Domicilio actual)
*
Your answer
Apt. No. (Num.de apto)
Your answer
City (Ciudad)
*
Your answer
State (Estado)
*
Your answer
Zip Code (Codigo Postal)*
*
Your answer
Are you volunteering as a member of the community without students enrolled in CISD?
*
Yes
No
If you are community volunteer please state purpose of visiting campus(es).
*
(Guest speaker, delivering items, etc.)
Your answer
Are you volunteering as a parent or family member?
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Yes
No
Please select the campus(es) where your student(s) attend, or where you plan to volunteer.
*
Dietz Elementary School
Martin Elementary School
Walker Elementary School
Wilson Elementary School
Crandall Middle School
Crandall High School
Crandall Alt School
Other:
Required
List all students in your family attending Crandall ISD.
*
Your answer
Previous Address
If you have lived at your current address less than five years, please list a previous address.
Your answer
Apt. No.
Your answer
City
Your answer
State
Your answer
Zip Code
Your answer
Texas Driver's License or State ID Number
*
Your answer
Other Driver's License/ID
Your answer
Social Security Number
xxx-xx-xxxx
Your answer
Electronic Signature- your typed name serves as your signature.
*
Your answer
DPS Computerized Criminal History (CCH) Verification
This copy must remain on file by your agency. Required for future DPS audits.
Signature of Applicant
*
Your answer
By checking her you acknowledge signing this document
*
acknowledgement
Required
Date
*
MM
/
DD
/
YYYY
FOR OFFICE USE ONLY
Crandall ISD Agency Representative Name
Your answer
Crandall ISD Signature of Agency Representative
Your answer
Date
Your answer
CCH Report Printed
Yes
No
Option 3
Clear selection
I, (Name of applicant), acknowledge that a Computerized Criminal History (CCH) check will be performed by accessing the Texas Department of Public Safety Secure Website and will be based on NAME and DOB identifiers I supply. (This is not a consent form.) Authority for this agency to access an individual's criminal history data may be found in Texas Government Code 411: Subchapter F. Name based information is not an exact search and only fingerprint record searches represent true identification to criminal history, therefore the organization conducting the criminal history check is not allowed to discuss with me any criminal history record information obtained using the name and DOB method. The agency may request that I have a fingerprint search performed to clear any misidentification based on the result of the name and DOB search. Once this process is completed the information on my fingerprint criminal history record may be discussed with me. In order to complete the process I must make an appointment with the Fingerprint Applicant Services of Texas (FAST) as instructed online at
www.txdps.state.tx.us/Crime
Records/Review of Personal Criminal History or by calling the DPS Program vendor at 1-888-467-2080, submit a full and complete set of my fingerprints, request a copy be sent to the agency listed below, and pay a fee of $24.95 to the fingerprinting services company.
*
Name of Applicant
Your answer
Purpose of CCH
Your answer
Hire
Not Hired
Date Printed
Date Destroyed
Clear selection
Initial
Your answer
Retain in your files
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