Employee records Volunteer Background Check Acknowledgment Leave this field emptyVolunteer serviceIn order to ensure the protection of children in the care of Harper Woods School District, school policy requires that all potential volunteers complete a fingerprint or State of Michigan ICHAT background check before providing any volunteer service at the school or for any function conducted by the school. If ICHAT is used, the background check is a name check only, based on individual identifiers. Any applicant declining to complete this acknowledgment form will not be considered.Service to provide *Date to provide service *Potential volunteer informationFull Printed Name *Maiden name or other name(s) previously usedDOB *Sex *Eye Color *Hair Color *Height *Race *History informationProviding false information, or information contradicting the background check, is grounds for immediate volunteer denial.1) Have you volunteered for the Harper Woods School District before? *YesNoWhich location?2) Have you ever pled guilty, or been convicted of a felony in a state or federal court? *YesNoDate and state offense/conviction occurredDetailed description of the convictionDescription — line 23) Have you ever pled guilty, or been convicted of a misdemeanor in a state or federal court? *YesNoDate and state offense/misdemeanor occurredDetailed description of the convictionDescription — line 24) Are you the subject of a current criminal investigation, or have pending charges against you? *YesNoDate and state the investigation is ongoingDetailed description of the investigation or pending chargesDescription — line 2Consent and contactHarper Woods School District reserves the right to approve or deny any volunteer service upon review of the background check returned. The determination will be based upon the individual's fitness to have responsibility for the safety and wellbeing of children.I acknowledge that my statements are true and give full consent to complete the requested background check. *Complete Address *Contact Number(s) *E-mail Address *Date Signed *Return the signed form to Harper Woods School District / 19851 Anita St. — Board Office, Harper Woods, MI 48225. Questions or concerns: Phyllis Greene, 586-209-2400. Attach a copy of your identification. The signature line and the Office Use Only section (identification verified, approved/denied, date and determining staff member initials) are completed on paper by the district.Submit and generate my acknowledgment form
