VOLUNTEER BACKGROUND CHECK FORM
In order to ensure the protection of children in the care of Hopkins Public Schools, school policy requires, prior to any and all persons providing a volunteer service at the school or for any function conducted by the school; all potential volunteers complete a State of Michigan background check. Any applicant declining to complete a "Volunteer Background Check" acknowledgement form will not be considered. The information below is needed to perform this check.
Email address *
Full Name:
Your answer
Maiden name or other names(s) used:
Your answer
DOB:
MM
/
DD
/
YYYY
Sex:
Ethnicity
Phone #:
Your answer
Service to Provide:
Your answer
Date to Provide Service:
MM
/
DD
/
YYYY
Building
Have you volunteered at Hopkins Public Schools before?
Have you ever pled guilty, or been convicted of a felony in a state or federal court?
If yes, provide a detailed description of the conviction, including the date and state the conviction occurred.
Your answer
Have you ever pled guilty, or been convicted of a misdemeanor in a state or federal court?
If yes, provide a detailed description of the conviction, including the date and state the conviction occurred.
Your answer
Are you the subject of a current criminal investigation or have pending charges against you?
If yes, provide a detailed description of the investigation or pending charges including the date and state the investigation in ongoing.
Your answer
Hopkins Public Schools reserves the right to "approve" or "deny" any volunteer service upon review of the background check returned through ICHAT. The determination will be based upon the individual's fitness to have responsibility for the safety and wellbeing of children. Providing false information, or information contradicting the background check information, is grounds for immediate volunteer denial. By selecting, I agree, to this form, you acknowledge your statements are true and give full consent to complete a name based background check through ICHAT.
AGREEMENT WITH VOLUNTEERS: I have offered my services as a volunteer/chaperone to help Hopkins Public Schools with the following event and/or activity:
Your answer
I agree to abide by relevant board policies and implementing procedures while on duty for the district. I understand further that, as a volunteer, I am not in any manner considered an employee of the district or entitled to any benefits or compensation provided to employees. I further release the Hopkins Public Schools 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, Hopkins Public Schools is required by law to inquire whether prospective chaperones for an overnight trip have been convicted of a crime related to children. Your agreement indicates assurance that you have not been convicted of such a crime and gives the district permission to conduct a background check with the Central Records Division of the Michigan State Police if we choose to do so. Volunteers are also required to agree to a background check for the sole purpose of obtaining a conviction only criminal history, by the school district, using the school district background consent form. The school district appreciates the work of each volunteer for the time and efforts provided in the assisting in the operation of the schools. The agreement below represents understanding of the agreement to the conditions listed above.
Submit
Never submit passwords through Google Forms.
This form was created inside of Hopkins Public Schools. Report Abuse - Terms of Service - Additional Terms