HURON VALLEY SCHOOLS

CRIMINAL RECORD CHECK FORM

In congruence with the state law for employees and to maintain student safety in Huron Valley Schools, anyone convicted of a felony or a misdemeanor criminal sexual offense will not be permitted to volunteer in the school district.

As a volunteer of Huron Valley Schools, I understand that it is the school district’s policy to secure criminal history information as part of its volunteer screening process using the information provided below.

Name: (Last) (First) (Middle)
Maiden Name/Names Previously Used:
Birthdate:	Race:		Gender: Male o Female o
Social Security #: optional	Driver’s License # : optional			State:
I understand that the above information is required by the Central Records Division of the Michigan State Police, Lansing, MI. I authorize Huron Valley Schools to utilize the above information for the sole purpose of obtaining a conviction only criminal history file search, pursuant to the Michigan Freedom of Information Act. (PA 442 of 1976).
Signature of Prospective Volunteer:		Date:
Telephone #:
You are required to fill-out one CRC per year. Please list all schools that your children attend in Huron Valley:

It is the policy of the Huron Valley Schools’ Board of Education that no person on the basis of race, color, religion, national origin or ancestry, age, sex, marital status or disability shall be discriminated against, excluded from participation in, denied the benefits of or otherwise be subjected to, discrimination in any program or activity.

I intend to volunteer at: □ Milford High School ڤ Lakeland High School

Revised 9/7/06