Fill out ONCE per school year!!!
All volunteers for CSC of Eastern Hancock field trips, clubs, classroom events, and any situation where a volunteer would be working directly with a student require a YEARLY background check to be completed.

*****You only need to fill out ONE FORM PER ADULT per school year.*****

COACHES OR STAFF DO NOT USE THIS FORM.
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Email *
This may include court, county, state, federal and national reporting for criminal and sexual offenses.  Reporting will be done through either/both of the following organizations:   •Safe Hiring Solutions LLC, P.O. Box 295, Danville, IN 46122 888-215-8296    •Indiana State Police, Central Repository, 100 N. Senate Ave., Indianapolis, IN 46204.  Before any adverse action is taken, based in whole or in part of the information contained in the consumer report, you will be provided a copy of the report, the name, address and the telephone number of the reporting agency, a summary of your rights under the Fair Credit Reporting act, as well as additional information on your rights under the law.  
LEGAL Name (first, middle & last): *
Social Security Number: *
Include dashes
Date of Birth (MM-DD-YYYY): *
MM
/
DD
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YYYY
Race (these are the only options provided by the Indiana Criminal History Request Service): *
Gender (these are the only options provided by the Indiana Criminal History Request Service): *
Country of Birth: *
State of Birth: *
Any other first or last names you have been known by (Ex. maiden name):
Current street address: *
City: *
State: *
Zip: *
List all previous addresses for the last 7 years if different from above:
Telephone number, including area code, to reach you if we have questions: *
Numbers only
List ALL STUDENTS in your family that you may possibly volunteer for this school year: *
By typing my name below, I hereby voluntarily authorize Community School Corporation of Eastern Hancock County to obtain either a consumer or an investigative consumer report about me from a consumer reporting agency and to consider this information when making decisions regarding my employment and/or continued employment at Community School Corporation of Eastern Hancock County.  I understand that I have rights under the Fair Credit Reporting Act, including rights discussed above. This report may be delivered in either written or electronic form.
Type full name to authorize: *
This form will now be submitted directly to the Eastern Hancock Administration Office for processing.
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