Volunteer Background Check/ICHAT
Please fill out each item below to be considered for volunteer work at DeWitt Public Schools. A new form must be submitted for each school year. Please note that a copy of this form will be sent to the e-mail address you provide below.
Email address *
Service to provide
First Name *
Your answer
Middle Name
Your answer
Last Name *
Your answer
Maiden name/names previously used
Your answer
Date of Birth *
MM
/
DD
/
YYYY
Race *
Gender *
Have you volunteered at DeWitt Public Schools before? *
Have you ever pleaded guilty, or been convicted of a felony in a state or federal court? *
If yes, date and state offense/conviction occurred:
Your answer
If yes, provide a detailed description of the conviction:
Your answer
Have you ever pleaded guilty, or been convicted of a misdemeanor in a state or federal court? *
If yes, date and offense/conviction occurred:
Your answer
If yes, provide a detailed description of the conviction:
Your answer
Are you the subject of a current criminal investigation or have pending charges against you? *
If yes, date and state the investigation is ongoing:
Your answer
If yes, provide a detailed description of the investigation or pending charges:
Your answer
Telephone number
Your answer
E-mail Address
Your answer
Location Requested *
Required
Criminal History Check
As a prospective volunteer of DeWitt Public Schools, I understand that it is this agency's policy to secure conviction/criminal history information as part of the pre-employment screening process or to be a volunteer using any information provided on this form.

I hereby recognize and agree that if the report received by the district from the department of state police is not the same as the statement on this form, my volunteer contract with the Board of Education will be voidable at the option of DeWitt Public Schools Board of Education, without regard to a collective bargaining agreement that would otherwise apply to such termination, as provided in the Act.

Further, I understand that the Central Records Division of the Michigan State Police, Lansing Michigan, requires the information in this form. I authorize the DeWitt Public Schools to utilize the information in this form for the sole purpose of obtaining a conviction only criminal history file search.

Criminal History Check Consent *
Required
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