CCS Background Check Request
Complete the form below to receive the links and instructions to complete both required checks. Applicants must be able to pass a background check to be employed with CCS. 
Ref. I.C. 20-26-5-11.2
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Name 
(First, Middle, Last)
 *
Phone Number (xxx-xxx-xxxx) *
Email Address *
Date of Birth (xx-xx-xxxx)
(If you do not want to include this information on this form, please call the office - 812-443-4461)
Social Security Number - 9 digit-(xxx-xx-xxxx)
(If you do not want to include this information on this form, please call the office - 812-443-4461)
In what capacity do you wish to serve CCS? *
Position/Sport/Activity Description: 
For which school or department? *
Required
Please submit my name to the school board to be approved as a volunteer/chaperone. 
All Volunteers/Chaperones must be approved by the school board. If you are completing a background check for another reason, but would still like to be able to chaperone or volunteer in the classroom, please check Yes below. 
Signature: 
I understand that I am required to obtain an Expanded Criminal History Check (ECHC) through Safe Hiring Solutions before I will be considered for approval. I hereby consent to that process. The fee, for which I will be responsible, must be paid online at the time of the request for the ECHC. My name may be submitted for approval by the school board after the results have been obtained by the central office personnel via the internet. Failure to honestly answer questions under the application is grounds for termination. In addition, I understand that I am required by state law to undergo a Child Protection Index Check (CPIC) through the Department of Child Services (DCS). For a Summary of Your Rights Under the Fair Credit Reporting Act, visit www.ftc.gov. 
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