Little North Attleboro League has been certified by the Criminal History Systems Board for access to conviction and criminal case data. As a (prospective) employee/volunteer for the position of ______________________, I understand that a criminal record check will be conducted for conviction and pending criminal case information only and that it will not necessarily disqualify me. The information below is correct to the best of my knowledge.
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(Prospective) Employee/Volunteer Signature
(PROSPECTIVE) EMPLOYEE/VOLUNTEER INFORMATION (PLEASE PRINT)
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| Last Name | First Name | Middle Name |
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Maiden Name or Alias (if applicable)
Date of birth: __________________ Social Security #: _____ _____ _____
(Requested but not required)
Address: ________________________________________________________
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Requested By: ____________________________________________
(SIGNATURE OF CORI AUTHORIZED EMPLOYEE)
CHBS USE ONLY
RECORD ATTACHED: ______________ NO RECORD: ___________