To be used by organizations conducting CORI checks for employment or licensing purposes.
Community Access Inc. is registered under the (Organization) provisions of M.G.L. c.6, § 172 to receive CORI for the purpose of screening current and otherwise qualified prospective employees, subcontractors, volunteers, license applicants, or current licensees.
As a prospective or current employee, subcontractor, volunteer, license applicant or current licensee, I understand that a
CORI check will be submitted for my personal information to the DCJIS. I hereby acknowledge and provide permission to Community Access Inc.
(Organization) to submit a CORI check for my information to the DCJIS. This authorization is valid for one year from the date of my Community Access Inc. signature. I may withdraw this authorization at any time by providing
with written notice of my intent to withdraw consent to a CORI check.