Northwest Allen County Schools
Limited Criminal Background Check
Northwest Allen County Schools requires a limited Criminal History Background Check as well as a copy of a driver’s license for all volunteers working in our school in any capacity at any time during the school year. If you will be working in a classroom, volunteering on a field trip or working with students in anyway, you are required to complete this form and return it to school with your child.
Please print and use your full LEGAL name.
Last Name: __________________________________ First Name:_______________________________________ Middle:_______________________________________
Date of Birth: _______________________ Gender: _______ Race: ________
Student’s Name(s): ____________________________________________________________________________
Grade(s) and Teacher(s): _______________ ________________________________________________________
Your relationship to student:______________________________
Are you currently a Northwest Allen County School employee? Yes No
If yes, what building do you work in?_____________________________
Are you currently a Northwest Allen County School substitute? Yes No
If yes, what position? Teacher Aide/Secretary Custodian/MatronFood Service Nurse Bus Driver Other_______________________
Today’s Date: ________________ Signature: ___________________________________________