CRIMINAL HISTORY RECORD/SEX OFFENDERS REGISTRYCONSENT FORM
As a prospective volunteer of Muskegon Public Schools, I understand that it is this Public School’s policy to secure criminal history information as part of their volunteer screening process using the information provided below.
Legal Name
*
First Name
Middle Name
Last Name
List all previous names: (Maiden, previous married names, etc.)
Date of Birth
*
-
Month
-
Day
Year
Date
Race
*
Gender
*
Male
Female
Other
Email
*
example@example.com
Confirm Email
*
example@example.com
Best Phone Number
*
Please enter a valid phone number.
Driver’s License/State ID #
*
Is this Application
*
New
Renewal
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Perferred Building
*
Bunker
Marquette
Oakview
Muskegon Middle
Muskegon High School
MCEC
No Preference
Your Building Name (if Applicable)
Student(s) who attend home building (if Applicable)
Example of drivers licenses photo
Please hold your drivers licenses as close to the camera as possible for clarity.
Please take a photo of your Driver's License/State ID for identification purposes.
*
Please take a photo of yourself
*
I understand that the above information is required by the Central Records Division of the Michigan State Police. I authorize Muskegon Public Schools to utilize the above information for the sole purpose of obtaining a criminal history and sex offender’s registry (SOR) file search
Signature
*
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Next
Disclaimer
Please inital below that you understand you will not be paid for your time as a volunteer.
Initials
*
Do you have volunteer experience?
Yes
No
Where?
*
Do you speak a language other than English?
*
Yes
No
What Language?
Do you have physical limitations?
*
Yes
No
Please explain
Are you a Muskegon Public Schools alumni?
*
Yes
No
What year did you graduate?
Please check one if you are a
Parent of a student
Grandparent of a student
Guardian of a student
Relative of a student
Community Member
Former MPS student
Other
Please explain
Emergency Contact Name
*
Phone Number
*
Please enter a valid phone number.
In what areas are you interested in volunteering? Please check the boxes you would like to be contacted about.
Assist in a classroom
Assist in the Music Department
Co-curricular activities
Coach a sports team
JROTC
Math tutor
Mentor students
Reading to children
Reading tutor
Recreational activities
School-to-career opportunities
Tutorting in a classroom
Chaporone a field trip
Chaporone a dance
After school event
Concession Stand
Fundraiser
Submit
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