VOLUNTEER LIMITED BACKGROUND CHECK FOR 2025/26

Please complete one form per volunteer per family every school year

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Email *

DISCLAIMER: The facts set forth on this form are true and complete to the best of my knowledge.  I understand that false statements on this form shall be considered sufficient cause for non-consideration as a volunteer.

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Required
Last Name *
Middle Name (or Non Applicable) *
First Name *
Maiden Name or Other Married Name(s) (or Non Applicable) *
AKA/Aliases (Other Names Used) (or Non Applicable) *
Date of Birth *
MM
/
DD
/
YYYY
Gender *
Race (Please mark 1) *
Have you ever been convicted, pleaded guilty or no contest before a court for any federal, state or municipal criminal offense, such as a misdemeanor/felony, regardless of when conviction occurred?  Please include any felony/misdemeanor driving offenses such as Driving While Suspended, DWI (Driving while under the influence) or OWI (Operating a vehicle under the influence).  Traffic infractions are not required for disclosure.              *
Have you ever been convicted of any criminal offense in a country outside the jurisdiction of the United States? *
Do you currently have any pending charges against you?           *
If YES to any of the 3 previous questions, complete the details on this separate form
Are you a student? *
Are you 18 years of age or older? *
School District (or Non Applicable) *
Parent Agreement (Required if student is under age of 18) *
Required

AUTHORIZATION: I understand that by checking the box below “I agree” and consent to Niles Community Schools to complete a limited background check and/or civil records using federal, state and local agencies for verification.  I understand I have rights under the Fair Credit Reporting Act, including having access to this report.  This information will be considered by NCS when making decisions regarding my application for volunteer services.

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Required

Volunteer Name (only one name per form)

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Home Phone *
Cell Phone *

Address: Street, City, State, Zip Code

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 Emergency Contact Person *
Emergency Contact Phone *

I do not have a student connection to Niles Community Schools, but I wish to volunteer at:

Clear selection
Please list your student connection(s) to Niles Community Schools:  
Student Name
 *
Teacher:
School Building/Teacher *
Relationship to student *
Please list your student connection(s) to Niles Community Schools:  
Student Name
Teacher:
School Building/Teacher
Clear selection
Relationship to student
Please list your student connection(s) to Niles Community Schools:  
Student Name
Teacher:
School Building/Teacher
Clear selection
Relationship to student
Please list your student connection(s) to Niles Community Schools:  
Student Name
Teacher
School Building/Teacher
Clear selection
Relationship to student
For more than 4 students, fill out the linked form
Note:  Volunteers may not volunteer until the background check is complete and email confirmation sent.
Please read the following:

 
1. A volunteer is a person from the community who contributes his/her services on a regular or intermittent basis and is approved by a district administrator.  

2. Volunteers can be assigned to help the teachers and administrators in providing instructional or extracurricular services to students.  

3. Volunteers cannot be assigned to relieve teachers and/or administrators of their employed responsibilities but are intended to support the objectives of the program/activity.  

4. Volunteers will work under the supervision of the designated teacher or administrator and will only work within the scope of the agreed upon work.  

5. Volunteers should not meet with the students outside of school program hours or off school grounds without prior approval from a district administrator.  

6. Volunteers should not discipline students.
 
7. Volunteers should not deal directly with parent concerns and should refer all contacts by parents to the teacher or administrator.
  
8. Volunteers should not perform tasks that they are physically unable to perform or lack the experience or skills needed.
  
9. Volunteers should not treat injuries, except in the case of emergency first-aid.
  
10. Volunteers are personally responsible for his/her actions. Inappropriate conduct may result in the individual being asked to discontinue his or her relationship with the district.
  
11. Volunteers should not drive a personal vehicle to transport students without prior District approval. A Request for Transportation by Private Vehicle form must be completed for approval.
  
12. Volunteers serve, and his/her tenure is at the discretion of the district administrator.
  
13. Volunteers cannot volunteer until the background check is complete and email confirmation sent.

Please read the following:

I agree to abide by all relevant Board policies and administrative guidelines located on the Niles Community Schools website (www.nilesschools.org) while on duty for the District. 

I understand that, although I am covered under the District’s liability insurance policy, I am not covered by its health insurance policy nor am I eligible for workers’ compensation.  Should I become ill or suffer an accident while doing volunteer work for the District, I agree that I shall be responsible for any and all hospital and medical charges that may accrue.

I understand further that as a volunteer, I am not in any manner considered an employee of the District or entitled to any benefits provided to employees.  I further release the Board of Education from any and all liability for any damages, whatever their nature, which may result as a consequence of my volunteer services.

For the protection of the children in the school, the District is required by law to inquire of its staff members whether or not they have ever been convicted of a crime related to children.  We would appreciate your cooperation by indicating that you have never been convicted of any of the following offenses:  aggravated murder, murder, voluntary manslaughter, involuntary manslaughter, felonious assault, aggravated assault, assault, aggravated menacing, abuse or neglect of a child, kidnapping, abduction, child stealing, criminal child enticement, rape, sexual battery, corruption of a minor, gross sexual imposition, importuning, voyeurism, public indecency, felonious sexual penetration, compelling prostitution, promoting prostitution, procuring prostitution, disseminating matter harmful to juveniles, pandering obscenity, pandering obscenity involving a minor, pandering sexually-oriented matter involving a minor, illegal use of a minor in nudity-oriented material or performance, endangering children, contributing to the delinquency of children, carrying concealed weapons, improperly discharging a firearm at or into a school or house, corrupting another with drugs, placing harmful objects in or adulterating food or confection.

By checking the box below I signify that I understand that the Board of Education must request a criminal history check on me from the Central Records Division of the Michigan Department of State Police.  I certify that I truthfully completed all information components and that false statements on this form shall be considered sufficient cause for non-consideration as a volunteer.    *
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