Volunteer Application
As an added measure to improve student safety, Rushford-Peterson Schools requires any person wishing to  volunteer agree to Name Based Criminal History Check. This application may take up to three (3) weeks to  process. 
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First Name *
Middle Name *
Last Name *
Home Address *
City *
State *
Zip *
Cell Phone *
Email *
Birth Date *
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Students at Rushford Peterson you will be volunteering with. (children, grand children, nieces, nephews, etc.) *

Have you ever been convicted of a felony or been convicted of a lesser charge in which the conviction was not  annulled or expunged according to law or was a misdemeanor charge for which no jail sentence has been imposed? 


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If you answered yes to the question above please explain.
I understand and agree that Rushford-Peterson Schools may obtain any criminal history record information  pertaining to me. The district may obtain such information from any law enforcement agency, including a police  department or the Department of Public Safety, or from the Minnesota Department of Corrections or similar out-of-state entities.

By signing below, I hereby give my voluntary consent to a criminal history check. I understand that certain  information obtained as a result of this criminal history check may preclude me from volunteering at Rushford Peterson Schools. I agree to conform to all district policies and procedures. 

I certify that all the information in this application is true and correct, and I further understand that any  misstatement or omission of information may be grounds for disqualification. I understand this application  becomes a public record and is subject to disclosure. I understand that I have the right to review and challenge any  negative information that would adversely impact my application. 

Further, I hereby hold harmless, release and fully discharge Rushford-Peterson Schools, its agents, officers,  or employees, from any and all liability, claims, causes of action, costs and expense which may be attributes to me  volunteering at Rushford-Peterson Schools and/or any and all liability for the criminal history check and any action  taken as a result of information obtained through the criminal history investigation.

Rushford-Peterson Schools is an equal opportunity employer and does not discriminate against persons because of age, race, color, creed, religion, disability, gender, ethnic or nation origin, or veteran status. Rushford-Peterson  Schools prohibits discrimination against individuals with disabilities and will reasonably accommodate applicants  with a disability, upon request, and will also ensure reasonable accommodation for employees with disabilities.  

By typing your name in the space provided, you acknowledge that it serves as your electronic signature.  
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