Volunteer ICHAT Form

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Volunteer ICHAT Form
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- Hiring Entity Name REQUIRED Please fill out this field. Please enter valid data.
- Church or School REQUIRED Please fill out this field.
- First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
- Middle Name Please enter valid data.
- Date of Birth (MM/DD/YYYY) REQUIRED Please fill out this field. Please enter a date.
- Known by any other name(s) (Maiden Name/Previous Names or Aliases Used) Please enter valid data.
- Address REQUIRED Please fill out this field. Please enter valid data.
- City REQUIRED Please fill out this field. Please enter valid data.
  
  State REQUIRED Please fill out this field.
  
  Zip REQUIRED Please fill out this field. Please enter a zip code.
- Numbers of years living in Michigan REQUIRED Please fill out this field. Please enter valid data.
- Phone Number REQUIRED Maximum 20 characters Please fill out this field. Please enter a phone number.
- Position/Title for which you are seeking/volunteering (ex: teacher, Janitor, Volunteer Coach, Chaperone, etc.) REQUIRED Please fill out this field. Please enter valid data.
- Driver's License #: REQUIRED Please fill out this field. Please enter valid data.
- Driver's License State Maximum 2 characters Please enter valid data.
- Race Please enter valid data.
- Gender REQUIRED Please fill out this field.
- The Diocese of Lansing hereby discloses and I understand that consumer reports and/or investigative consumer reports on my background may be made, to assess me in a connection with hire or volunteer assignment, promotion or reassignment or retention. These reports may be obtained before initial hire or volunteer assignment or during my employment or volunteer assignment and may consist of a criminal history background check, driving record, education verification, employment verification, credit check, and/or personal references using the services of the Diocese of Lansing/Department of Human Resources and/or a designated outside firm. The information received, including this form, will be kept confidential and will be used only to determine suitability to work at the Diocese of Lansing, a diocesan school, parish, or agency, or volunteer for the above noted entity.
  
  By selecting this box, I authorize the Diocese of Lansing or a designated consumer reporting agency to obtain information and authorize without reservation, any party contacted to furnish any or all of the above-mentioned information. Further, I will allow a photocopy of this authorization to be as valid as the original for purposes conducting the necessary investigation.
  
  In addition, I agree to abide by the policies, procedures and code of conduct that currently exist or may be amended in the future.
  
  I Agree Please select this field.
- Todays Date REQUIRED Please fill out this field. Please enter a date.
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*Note: Date of Birth, gender, and race are being requested only for the purposes of identification in obtaining accurate retrieval of records.