Volunteer Background Check Authorization Form


    The West End House Boys & Girls Club of Allston-Brighton (WEH) is registered under the provisions of M.G.L. c. 6, § 172 to receive CORI for the purpose of screening current and otherwise qualified prospective employees, subcontractors, volunteers, license applicants, current licensees, and applicants for the rental or lease of housing.

    As a prospective or current employee, subcontractor, volunteer, license applicant, current licensee, or applicant for the rental or lease of housing, I understand that a CORI check will be submitted for my personal information to the DCJIS. I hereby acknowledge and provide permission to WEH to submit a CORI check for my information to the DCJIS. This authorization is valid for one year from the date of my signature. I may withdraw this authorization at any time by providing WEH with written notice of my intent to withdraw consent to a CORI check.

    FOR EMPLOYMENT, VOLUNTEER, AND LICENSING PURPOSES ONLY: WEH may conduct subsequent CORI checks within one year of the date this Form was signed by me provided, however, that WEH must first provide me with written notice of this check.
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    Important: Please Read Carefully Before Signing Authorization

    Disclosure Regarding Background Investigation

    The West End House Boys & Girls Club (WEH) may obtain information about you for employment/volunteer purposes from a third-party consumer reporting agency. Thus, you may be the subject of a “consumer report” and/or an “investigative consumer report” which may include information about your character, general reputation, personal characteristics, and/or mode of living. These reports may contain information regarding criminal history, social security verification, motor vehicle records (“driving records”), verification of your education or employment history, or other background checks. You have the right, upon written request made within a reasonable time after receipt of this notice, to request disclosure of the nature and scope of any investigative consumer report. The scope of this notice and authorization is all-encompassing, allowing WEH to obtain from any outside organization all manner of consumer reports and investigative consumer reports now and throughout the course of your employment/volunteerism to the extent permitted by law. As a result, you should carefully consider whether to exercise your right to request disclosure of the nature and scope of any investigative consumer report.

    Acknowledgement and Authorization

    I acknowledge receipt of the Disclosure Regarding Background Investigation and certify that I have read and understand the document. I hereby authorize the obtaining of “consumer reports” and/or “investigative consumer reports” by WEH at any time after receipt of this authorization and throughout my employment/volunteerism, if applicable. To this end, I hereby authorize, without reservation, any law enforcement agency, administrator, state of federal agency, institution, school or university (public or private), information service bureau, employer, or insurance company to furnish any and all background information requested by LexisNexis Screening Solutions Inc. on behalf of WEH. I agree that a facsimile (“fax”), electronic, or photographic copy of this Authorization shall be as valid as the original.
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