Get Framingham Schools Cori Form

I may withdraw this authorization at any time by providing Framingham Public Schools with written notice of my intent to withdraw consent to a CORI check. FOR EMPLOYMENT VOLUNTEER AND LICENSING PURPOSES ONLY The Framingham Form was signed by me provided however that Framingham Public Schools must first provide me with written notice of this check. By signing below I provide my consent to a CORI check and acknowledge that the information provided on Page 2 of this Acknowledgement Form is true and accurate. Framingham Public Schools 31 Flagg Drive Framingham MA 01702 CRIMINAL OFFENDER RECORD INFORMATION CORI ACKNOWLEDGEMENT FORM TO BE USED BY ORGANIZATIONS CONDUCTING CORI CHECKS FOR EMPLOYMENT VOLUNTEER SUBCONTRACTOR LICENSING AND HOUSING PURPOSES receive CORI for the purpose of screening current and otherwise qualified prospective employees subcontractors volunteers license applicants current licensees and applicants for the rental or lease of housing. As a prospective or current employee subcontractor volunteer license applicant current licensee or applicant for the rental or lease of housing I understand that a CORI check will be submitted for my personal information to the DCJIS. I hereby acknowledge and provide permission to Framingham Public Schools to submit a CORI check for my information to the DCJIS. This authorization is valid for one year from the date of my signature. FOR EMPLOYMENT VOLUNTEER AND LICENSING PURPOSES ONLY The Framingham Form was signed by me provided however that Framingham Public Schools must first provide me with written notice of this check. By signing below I provide my consent to a CORI check and acknowledge that the information provided on Page 2 of this Acknowledgement Form is true and accurate. SIGNATURE DATE REQUESTING LOCATION CORI 5/12 SUBJECT INFORMATION Last Name First Name Middle Name Suffix Maiden Name or other name s by which you have been known Date of Birth Place of Birth Last Six Digits of Your Social Security Number Sex Height ft. in* Eye Color Race Driver s License or ID Number State of Issue Mother s Full Maiden Name Father s Full Name Current and Former Addresses Street Number Name City/Town State Zip The above information was verified by reviewing the following form s of government issued identification VERIFIED BY Name of Verifying Employee Please Print Signature of Verifying Employee. By signing below I provide my consent to a CORI check and acknowledge that the information provided on Page 2 of this Acknowledgement Form is true and accurate. SIGNATURE DATE REQUESTING LOCATION CORI 5/12 SUBJECT INFORMATION Last Name First Name Middle Name Suffix Maiden Name or other name s by which you have been known Date of Birth Place of Birth Last Six Digits of Your Social Security Number Sex Height ft. SIGNATURE DATE REQUESTING LOCATION CORI 5/12 SUBJECT INFORMATION Last Name First Name Middle Name Suffix Maiden Name or other name s by which you have been known Date of Birth Place of Birth Last Six Digits of Your Social Security Number Sex Height ft. in* Eye Color Race Driver s License or ID Number State of Issue Mother s Full Maiden Name Father s Full Name Current and Former Addresses Street Number Name City/Town State Zip The above information was verified by reviewing the following form s of government issued identification VERIFIED BY Name of Verifying Employee Please Print Signature of Verifying Employee.