TO BE USED BY ORGANIZATIONS CONDUCTING CORI CHECKS FOR
EMPLOYMENT, VOLUNTEER, SUBCONTRACTOR, LICENSING, LENDING AND HOUSING PURPOSES
Community Teamwork, Inc. is registered under the provisions of
M.G.L. c. 6, ยง172 to receive CORI for the purpose of screening current and
otherwise qualified prospective employees, subcontractors, volunteers, license
applicants, current licensees, loan applicants 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 Community
Teamwork, Inc. 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 Community
Teamwork, Inc. with written notice of my intent to withdraw consent to a
CORI check.
FOR EMPLOYMENT, VOLUNTEER, AND
LICENSING PURPOSES ONLY:
Community
Teamwork, Inc. may conduct subsequent CORI checks within one year of the date this
Form was signed by me provided, however, that Community Teamwork, Inc. must first provide me with written notice
of this check.
By signing below, I provide my
consent to a CORI check and acknowledge that the information provided on Page 2
of this Acknowledgement Form is true and accurate.