Background Check Form

In order to ensure the protection of children in the care of Lenawee Christian School and the Christian Family Centre, policy requires, prior to any and all persons providing a volunteer service at the school or for any function conducted by the school; all potential volunteers complete a State of Michigan ICHAT background check. ICHAT, the background check, is a name check only through the State of Michigan ICHAT system, and is based on individual identifiers. Any applicant declining to complete a “Volunteer Background Check” acknowledgment form will not be considered for any volunteer position.

Name

First Name

Last Name

Maiden Name or other name(s) previously used

Phone

(###)

###

####

Date of Birth

YYYY

Sex

Eye Color

Hair Color

Height

Ethnicity

1) Have you volunteered at Lenawee Christian School or the Christian Family Centre previously?

Yes

2) Have you ever pled guilty, or been convicted of a felony in a state or federal court?

Yes

In what state did the offense/condition occur and when?

Date and state offense/conviction occurred:

If yes, provide a detailed description of the conviction:

3) Have you ever pled guilty, or been convicted of a misdemeanor in a state or federal court?

Yes

If yes, provide a detailed description of the conviction:

4) Are you the subject of a current criminal investigation or have pending charges against you?

Yes

Date and state the investigation is ongoing:

If yes, provide a detailed description of the investigation or pending charges:

Permission to Submit A Background Check

I agree

Entry Date

YYYY

Background Check Form

6 Questions

Every Parent Should Ask Before Choosing Their Student’s School

Lenawee Christian School

Resources

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