2018-2019 Kearsley Community Schools Volunteer Form

By completing this form, you are authorizing Kearsley Community Schools to perform a background check as part of our screening process for volunteers. Additional checks may be run periodically throughout the school year.

First Name *

Your answer

Middle Name *

Your answer

Last Name *

Your answer

Email address *

Your answer

Phone Number *

Your answer

Date of Birth *

YYYY

Race *

American Indian or Alaskan native

Asian or Pacific Islander

Black

Unknown/Other

White

Gender *

Female

Male

Prefer not to say

Driver's license or State ID number *

Your answer

Other First name

Your answer

Other Middle name

Your answer

Other Last name

Your answer

Building(s) you are wishing to volunteer at (select all)

Weston Elementary

Dowdall Elementary

Fiedler Elementary

Armstrong Middle School

AMS Athletics

Kearsley High School

KHS Athletics

Pumpkin Patch

Pursuant to Public Act 68 of 1993 and Public Act 83 of 1995, please answer the following questions: 1) Have you ever plead guilty, or been convicted of a felony in a state or federal court? If yes, please provide a detailed description of the conviction: *

Your answer

2) Have you ever pled guilty, or been convicted of a misdemeanor in a state or federal court? If yes, please provide the date and state offense/conviction occurred and a detailed description of the conviction. *

Your answer

3) Are you the subject of a current criminal investigation or have pending charges against you? If yes, please provide a detailed description of the investigation or pending charges: *

Your answer

I understand Kearsley Community Schools is requesting this information as part of the screening process for potential volunteers and the results will be kept confidential. The personal information included on this form is required in order to process a criminal history background check by the Central Records Division of the Michigan State Police. By entering your initials in the box below, you are effectively providing your signature, indicating that all the information on this form is true and accurate, to the best of your knowledge. To complete your application, please email a photo of your driver's license to tbrown@kearsleyschools.org *

Your answer

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