Criminal History Authorization & Waiver of Liability and Release of Claims

As a prospective volunteer of Grand Rapids Public Schools, I authorize Grand Rapids Public Schools to request from the Criminal Records Division of the Department of State Police and the Grand Rapids Police Department a criminal history check prior to an offer using the information below.

Legal First Name *

Middle Name

Legal Last Name *

Maiden/Names Previously Used

Date of Birth * 🛈 +

Age *

Race and Ethnicity (select all that apply) * 🛈

Sex * 🛈

Male

Female

Non-binary

Do you have a felony? *

Yes

No

Does the Appeals Committee have permission to review and discuss your conviction? *

Yes

No

N/A (Not applicable)

Have you been convicted of, or pled guilty or nolo contendere (no contest), to any crimes, including felonies AND/OR misdemeanors (but not including traffic citations unless they resulted in the suspension or revocation of your driver's license)? * 🛈

Yes

No

If applicable, please explain convictions, including both felonies and misdemeanors.

I understand and agree to the following statements (check boxes): *

I understand that the above information is required by the Central Records Division of the Michigan State Police, Lansing, Michigan and the Grand Rapids Police Department, Grand Rapids, Michigan. I hereby release and forever discharge Grand Rapids Public Schools, the State of Michigan and the City of Grand Rapids and their agents, officers, and employees from any and all actions, causes, claims and demands for, upon or by reason of any damage, loss, or injury, which may be sustained by me in nature of libel, slander, invasion of privacy or other resulting from errors or omissions in the information given or from the use of the information, whether by reason of unauthorized use, negligence or otherwise.

I certify that the answers given herein are true and complete to the best of my knowledge. I authorize investigation of all statements contained in this application to volunteer in the Grand Rapids Public Schools, and I have voluntarily signed the attached Criminal History Authorization/Waiver of Liability and Release of Claims form. I further understand and agree that I have an obligation to immediately notify the building administrator and/or school official if I am charged with and/or convicted of any crime, whether felony or misdemeanor (does not include traffic citations, unless the traffic violation resulted in the suspension or revocation of your driver's license). This application shall be considered active for a period of time not to exceed 100 days. Any applicant wishing to be considered beyond this time period should inquire as to whether or not the applications are being accepted. I understand and acknowledge that any volunteer relationship with the Grand Rapids Public Schools is of an "at will" nature, which means that the volunteer may resign at any time and the Grand Rapids Public Schools may release the volunteer at any time with or without cause. There is no entitlement or property right to be a volunteer in the Grand Rapids Public Schools. It is further understood that the "at will" relationship may not be changed by any written document, unless such change is specifically acknowledged in writing by the Superintendent. By signing this form, I understand that false and/or misleading information given in this application or any interviews will result in release. I understand that volunteers serving in the District serve without financial compensation. I understand also that I am required to abide with and am bound by all policies, rules/regulations and procedures of the District.

I acknowledge that as a part of my volunteer activities I may have access to confidential student information. This information may be in the form of student's address and telephone number, grades, medical conditions, performance on classroom assignments or disciplinary matters. I also understand that this information is protected by the Family Educational Rights and Privacy Act (FERPA) and the disclosure of confidential student information without permission is a violation of the law. I will not , under any circumstances, disclose the confidential or personally identifiable student information of Grand Rapids Public Schools students to any entity without the prior written consent of GRPS, the parent or eligible student (students 18 years or older). I have read and understood the above confidentiality statement and agree to comply with it.

Please sign *

clear

Volunteer Information

Street Address *

City *

State *

Zip Code *

Phone Number *

Email Address 🛈

Where would you like to pick up your volunteer badge: * 🛈

If your child(ren) attends Grand Rapids Public Schools, list their name(s) here:

If you are volunteering with a specific program, organization, school, or business, please list here:

You will receive a confirmation email within 10 minutes of submitting your application.