Employee and Volunteer Criminal Background Check Disclosure and Authorization Form

As a church we value the safety of children in our care, our employees and volunteers and the people whom we serve. We want to take prudent measures to protect our human and material resources. Therefore, the diocese mandates that criminal history background checks be conducted for all school/church personnel and volunteers, who may have unsupervised contact with a child, the elderly, or persons with disabilities. Please complete this form of basic information about you, which assures the best possible program and safety for all and return this form to the designated administrator for criminal background checks at your Parish/School/Central Services.

(Maiden Name/Previous Names or Aliases Used):

Disclosure/Authorization: The Diocese of Lansing hereby discloses, and I understand that consumer reports and/or investigative consumer reports on my background may be made, to assess me in connection with hire or volunteer assignment, promotion or reassignment or retention. These reports may be obtained before initial hire or volunteer assignment or during my employment or volunteer assignment and may consist of a criminal history background check, driving record, education verification, employment verification, credit check, and/or personal references using the services of the Diocese of Lansing/Department of Human Resources and/or a designated outside firm. The information received, including this form, will be kept confidential and will be used only to determine my suitability to work at the Diocese of Lansing, a diocesan school, parish, or agency, or volunteer for the above noted entity. I authorize the Diocese of Lansing or a designated consumer reporting agency to obtain the information and authorize without reservation, any party contacted to furnish any or all the above-mentioned information. Further, I will allow a photocopy of this authorization to be as valid as the original for purposes conducting the necessary investigation. In addition, I agree to abide by the policies, procedures and code of conduct that currently exist or may be amended in the future. *NOTE: Date of birth, sex, and race are being requested only for purposes of identification in obtaining accurate retrieval of records.

1. In my personal and professional life, I am committed to growing in virtue and holiness and I will exemplify the moral teachings of the Catholic Church. I will not teach, advocate, model, or in any way encourage beliefs or behaviors that are contrary to the teaching of the Catholic Church. 2. I will treat with respect, courtesy and charity each person who comes to a parish, school or agency of the Diocese of Lansing for any reason. I will take reasonable steps to protect the physical and emotional safety of all such persons. I will not abuse the authority granted to me by my assigned position. 3. In serving the young, I will exercise sound judgment at all times: I will be particularly sensitive to any actual or perceived risk of sexual impropriety; any physical contact with a person under the age of eighteen will be limited, appropriate, non-sexual and public. 4. Both in person and through all communication media, including social media, I will maintain appropriate relationship boundaries with clergy, religious, volunteers, parents, students, parishioners, clients and all other persons with whom I work or serve. 5. I understand that sexual harassment, sexual contact, or other improper physical contact (for explanation of these terms, see Section II of Employee Handbook) are absolutely forbidden in any parish or school or other agency of the Diocese of Lansing; physical contact with any person must always be limited, appropriate, nonsexual and public. 6. I will not distribute, send, knowingly receive, or possess pornographic images of adults or children. 7. I understand that the financial resources of the diocese, parish, school, or other agency within the diocese belong to the respective agency and may only be used for the purposes of that agency. I will not misuse, divert, or embezzle these financial resources, including parish (or other agency) credit cards, bank or investment accounts, expense accounts, or other funds or accounts, whether for personal benefit or otherwise. 8. Without prejudice to canons 983 and 984 regarding the inviolable seal of the Sacrament of Penance, I will immediately report ongoing physical, sexual, financial or other criminal misconduct to civil authorities and to the appropriate person within the diocese. I will report all other misconduct, including past criminal misconduct or other misconduct, to the appropriate person within the diocese. If I am uncertain to whom to make such a report, or uncertain whether to report to the civil authorities, I will contact the diocesan legal office (517-342-2522) or the Chancellor of the Diocese (517-342-2454 9. Except as noted in the preceding paragraph, I will maintain any confidence that I learn or receive in the course of my service. 10. While fulfilling my assigned responsibilities, I will not smoke or use profane language; I will not possess, use, or be under the influence of alcohol or drugs (including marijuana); and I will not possess a weapon. I have received, read and understand this Code of Conduct for the Roman Catholic Diocese of Lansing. I understand that I am subject to a thorough background check that may include fingerprinting and a criminal history. This may occur at the outset of my service and may occur again at any time, without notice or reason. I understand that any action or inaction inconsistent with this Code of Conduct may result in my termination or removal.

Signature Parish/School/Agency

From the Office of Child and Youth Protection

Approved by Bishop Earl Boyea on 3/2020