Communities In Schools of South Central Texas

 

Authorization for Criminal Background Check

 

 

 

I understand that it is a requirement that all employees and volunteers of the Communities In Schools programs in Texas, successfully pass a Criminal Background Check in order to work for or volunteer with this school-based program.  By my signature below, I give permission to Communities In Schools of South Central Texas to obtain any history of criminal records I might have.  I understand that if there are records as noted below, that I will be unable to work for or volunteer for this CIS program.   All records will remain confidential.

 

 

 

Prohibitive records include:

Any offense under Title 5 of the Texas Penal Code (offenses against the person)

Any offense under Title 6 of the Texas Penal Code (offenses against the family)

Any offense under Title 9 of the Texas Penal Code (offenses involving public indecency)

Any individual who has committed an offense under the Texas Controlled Substance Act, Chapter 481 of the Health & Safety Code within 10 years prior to the date of employment or volunteer status

Any individual who has committed a felony

Any individual who has committed a misdemeanor involving moral turpitude within 10 years prior to the date of employment or volunteer status

 

 

 

By signing below, I hereby swear and affirm that I have not been convicted of any of the offenses listed above.  I authorize a criminal background check now and at any time in the future that I retain my employment or my volunteer status with Communities In Schools of South Central Texas.

 

 

 

Have you lived outside the State of Texas within the last three years?   ____Yes     ____No

 

 

Full Name (please print) ____________________________________  DOB _____________

 

Address ____________________________________________________________________

 

 

 

Signature ____________________________________