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CHRI/CORI Consent Form

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NORTHERN BERKSHIRE VOCATIONAL REGIONAL SCHOOL DISTRICT

70 Hodges Cross Road
North Adams, MA 01247
Tel (413) 663-5383 | ​​​​​​​Fax (413) 664-9424

CRIMINAL OFFENDER RECORD INFORMATION (CORI)
CRIMINAL HISTORY RECORD INFORMATION (CHRI)
CONSENT FORM

Northern Berkshire Vocational 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, students or volunteers. Similarly, as authorized by M.G.L. c. 71 § 38R and M.G.L. c. 6 §§ 167-178, fingerprint based CHRI checks are also required.

As a prospective or current employee, subcontractor, student or volunteer, I understand that a CORI/CHRI check will be submitted for my personal information to the DCJIS. I hereby acknowledge and provide permission to submit a CORI/CHRI 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 written notice of my intent to withdraw consent to a CORI/CHRI check.

By signing below, I provide my consent to a CORI/CHRI check and acknowledge that the information provided on this acknowledgement form is true and accurate.

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A copy of your driver's license or government identification is required for processing.
If you are not able to submit a copy of your current driver's license or government identification, please stop by the district office located at 70 Hodges Cross Road, North Adams, MA 01247 for assistance.

Typing your name in the signature section below will serve as an electronic signature for the purpose of this request.

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