Criminal History Form

Step 3 of 5

Criminal History Policy
Due to the sensitive nature of the work performed in this program, individuals with certain types of criminal convictions may not be suitable for volunteering. Therefore, the program reserves the right to do a criminal history check at any time. Although some convictions; especially for such offenses as theft, abuse, neglect, or assault, may affect your suitability for volunteering, criminal convictions do not automatically disqualify you. The circumstances of each case will be evaluated against the requirements of the position to determine suitability for volunteering. Convictions as a juvenile will not be considered.

    Criminal History Statement
    In accordance with the program’s criminal history policy, the program reserves the right to perform a criminal history check at any time. In order that we may do so, please answer the question below.
    Have you ever been convicted of a crime? YesNo

    Note: In answering the above question, DO NOT report convictions that have been expunged, pardoned, or set aside; or arrests which did not result in a conviction; offenses as a juvenile; or offenses for which only a fine and no jail sentence was imposed.
    Certification of Volunteer



    By checking this box and typing my name above, I am electronically signing this release form. I understand that checking this box constitutes a legal signature confirming that I acknowledge and agree to the above Terms of Acceptance.
    I consent to my submitted data being collected and stored.

    (NOTE: These checkboxes MUST be checked in order to submit the form.)