Harvard Youth Baseball/ Softball Cori Request Form (Page 2 of 2) in pdf

Harvard Youth Baseball/ Softball Cori Request Form Page 2

HARAA

HARVARD YOUTH BASEBALL/ SOFTBALL

CORI REQUEST FORM

Harvard Youth Baseball has been certified by the Criminal History Systems Board for access

to conviction and pending criminal case data. As an applicant for Volunteering to Support

Youth Baseball, 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.

_____________________________________________________

(Applicant Signature)

__________________________

______________________

___________________________

LAST NAME

FIRST NAME

MIDDLE NAME

__________________________________

MAIDEN NAME OR ALIAS (IF APPLICABLE)

PLACE OF BIRTH

DATE OF BIRTH:______________ SOCIAL SECURITY NUMBER: ______-____-_______

(Requested but not required)

MOTHER’S MAIDEN NAME:_________________________________________________________

CURRENT AND FORMER

ADDRESSES:______________________________________________________________________

_________________________________________________________________________________

________________________________________________________________________________

SEX:________ HEIGHT:___________ WEIGHT:____________ EYE COLOR:__________________

STATE DRIVER’S LICENSE NUMBER:________________________________________________

*THE INFORMATION WAS VERIFIED WITH THE FOLLOWING FORM OF GOVERNMENT ISSUED

PHOTOGRAPHIC IDENTIFICATION:___________________________________________

REQUESTED BY:_______________________________________________________

SIGNATURE OF CORI AUTHORIZED EMPLOYEE

Harvard Youth Baseball/ Softball Cori Request Form Page 2