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.
* Required
First Name
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Your answer
Middle Name
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Your answer
Last Name
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Your answer
Email address
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Your answer
Phone Number
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Your answer
Date of Birth
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MM
/
DD
/
YYYY
Race
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American Indian or Alaskan native
Asian or Pacific Islander
Black
Unknown/Other
White
Gender
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Female
Male
Prefer not to say
Driver's license or State ID number
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Your answer
Other First name
Your answer
Other Middle name
Your answer
Other Last name
Your answer
Building(s)/activity 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
8th grade Washington D.C. trip
KHS Band/Choir Florida trip
Youth sports coaching
Band
Choir
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:
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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.
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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:
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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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