HomeMy WebLinkAbout01-1418-Criminal-History-Information_Rev_1Dennis Yarmouth Intermediate Middle School January 19, 2021
Dennis Yarmouth Regional School District 100% Construction Documents
Perkins Eastman DPC, project #71011
SECTION 01 1418 – CRIMINAL HISTORY INFORMATION 1 of 2
SECTION 01 1418
CRIMINAL HISTORY INFORMATION
Part 1 – General
1.0 RELATED DOCUMENTS: This section is only a portion of the Contract Documents. All of the
Contract Documents, including Conditions of the Contract and Division 1 General
Requirements, apply to this section. This section applies to all specification sections and work
of the Contract.
1.1 SECTION INCLUDES: Requirements for Criminal Background Check as condition of
employment and permission to work on Owner’s property.
A. Mandatory Identity Verification: Verify the identity of all persons working on site.
1. Use government issued documents with photographs such as driver’s license or
passport.
B. Mandatory Criminal Background Check: 7 working days prior to allowing person to work
on site:
1. Provide to the OPM completed CORI forms (appendix) and copy of proper
identification (copy of valid drivers license is preferred).
2. CORI will be processed by the District / Town, OPM will be notified of the results.
3. When cleared OPM will issue numbered sticker to be affixed to the right side of
the individuals hard hat (PPE). In order to obtain sticker the individual must
present the government issued ID to the OPM at the time of pick-up or the sticker
will not be released.
C. Owner’s Decision: The Owner may exclude any person from work on the Owner’s
property due to reasonable concern about the person’s Criminal Background.
D. Inequality of Criminal Offense: Assault, theft, vandalism, arson, embezzling, check fraud,
crimes involving fire arms, illegal drug possession or distribution, and sexual offenses
may be judged more significant than other criminal offenses for work related to this
Contract.
E. Right to Due Process: All persons subject to Criminal Background Check shall be given
opportunity to challenge the accuracy and relevancy of Criminal Background Check
results.
1. All persons shall be given due process protections to which they are entitled by
law or by applicable collective bargaining agreements.
F. Applicable Law: Without limitation, comply with all laws and regulations of authorities
having jurisdiction.
G. Non Disclosure: Maintain Criminal Background Check information confidential and
secure, even if the information was obtained from public records.
1. Prior to having access to Criminal Background Check information, all persons
shall sign an Agreement of Non-Disclosure approved by the Owner’s legal
counsel.
2. Keep Criminal Background Check information in a locked file controlled by
persons authorized by the Owner.
Dennis Yarmouth Intermediate Middle School January 19, 2021
Dennis Yarmouth Regional School District 100% Construction Documents
Perkins Eastman DPC, project #71011
SECTION 01 1418 – CRIMINAL HISTORY INFORMATION 2 of 2
3. Destroy Criminal Background Check information at completion of the Contract.
End of Section
Revised: 10/3/18
Dennis-Yarmouth Regional School District
296 Station Avenue
South Yarmouth, MA 02664
Phone (508)398-7600 Fax (508)398-7622
CRIMINAL OFFENDER RECORD INFORMATION (CORI) ACKNOWLEDGEMENT FORM
Dennis-Yarmouth Regional School District 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, and volunteers.
As a prospective or current employee, subcontractor, or volunteer, I understand that a CORI check will be submitted for my
personal information to the Department of Criminal Justice Information Services (DCJIS). I hereby acknowledge and provide
permission to Dennis-Yarmouth Regional School District (DYRSD) 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
DYRSD Human Resource Office with written notice of my intent to withdraw consent to a CORI check.
DYRSD may conduct subsequent CORI checks within one year of the date this form was signed by me, provided, however, that
DYRSD must first provide me with written notice of this check.
PURPOSE FOR CORI – PLEASE CHECK ONE BOX
□Employee (current) □Employee Applicant____________________________ (position applied for)
□Volunteer/Chaperone □Student Intern/Observer □Subcontractor_______________________ (Employer)
The fields marked with an asterisk (*) are required fields. Please print legibly in pen!
*First Name*_______________________________ Middle Initial ____________
*Last Name* _______________________________ Suffix (Jr., Sr., etc.) ______
Former Last Name 1 _________________________________Former Last Name 2 _________________________________
Former Last Name 3 _________________________________Former Last Name 4 _________________________________
*Date of Birth (MMDDYYYY)*______________________ Place of Birth _____________________________
*Last SIX digits of Social Security Number* ____ ____ -- ____ ____ ____ ____
Sex ______ Height ________ Eye Color ___________ Race _______________
Driver’s License or ID Number _____________________ Sate of Issue ___________
Father’s Full Name _____________________________ Mother’s Full Name __________________________
*Current Full Address _______________________________________*Current Phone Number* ______________________
By signing below, I provide my consent to a CORI check and affirm that the information on this Acknowledgement Form is true
and accurate.
_____________________________________________ ____________________
*SIGNATURE OF CORI SUBJECT Date
For Office Use Only:
The above information was verified by reviewing the following form(s) of government issued photo identification (please check one
box) and a copy of the ID is attached:
□ Driver’s License □ Passport □ Military I.D. □ State I.D.
NAME OF EMPLOYEE VERIFYING: _____________________________ VERIFYER’S SIGNATURE__________________________
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