Oxford Little League Cori Form printable pdf download

Oxford Little League Cori Form

Oxford Little League

P.O. Box 112

Oxford, MA 01540

(508)-987-0358

XOFDLL

FE370

Oxford Little League has been certified by the Criminal History Systems for access to

conviction and pending criminal case data to screen current and otherwise prospective

employees and volunteers who have the potential for unmonitored access to children. As

a (prospective) employee/volunteer for the position of _______________, I understand

that a criminal record check will be conducted for conviction and pending criminal case

information only and that it will not necessarily disqualify me. The information below is

correct to the best of my knowledge.

_________________________________________

(Prospective) Employee/Volunteer Signature

_(PROSPECTIVE) EMPLOYEE/VOLUNTEER INFORMATION (PLEASE PRINT)_

________________________________________________________

Last Name

First Name

Middle Name

__________________________________________

Maiden Name or Alias (if Applicable)

Date of Birth: ____/____/________

Social Security Number: ______-____-________

Address:

_______________________________________________

Requested by:

__________________________________

Signature of CORI Authirized Employee

CHSB USE ONLY

Record Attached: ________________

No Record: ________________

Oxford Little League Cori Form