Parent/Guardian Background Release – Human Resources

"*" indicates required fields

Disclosure

Parent/Guardian's Legal Name *

First Last Suffix

Email *

Indicate the nature of your relationship to the minor child? *

Parent

Legal Guardian

Other

Do you hereby represent that you are the parent or guardian of the minor (under 18 years old) whose name appears below? *

Consent is required in order for the minor child to be employed at Kalamazoo College.

Yes, I have read and consent and agree to the terms and provisions set forth in this Waiver on behalf of myself and said minor.

No, I do not consent or agree.

Reason for Submission and Associated Unit

Name of the unit in which the minor will be working, volunteering, or otherwise associated. *

Minor's Legal Information

Minor's Legal Name *

First Middle Last Suffix

Address *

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Email *

Primary Phone *

Date of birth *

Gender *

Female

Male

Other

Social Security Number *

Other name(s) used

Criminal History

Are there any felony charges pending against the minor? *

Yes

Please indicate the crime(s), country, state, county, and year. *

Have they ever been convicted of a crime? *

Yes

Please indicate the crime(s), country, state, county, and year. *

Work Permits

Minors under the age of 18 are required to have a work permit prior to starting work. Minors under the age of 18 cannot be employed or permitted to work, with or without pay, or volunteer until the person, company, business, firm or corporation proposing to employ the minor obtains and keeps on file at the minor’s place of employment (work location) a current and valid age appropriate work permit, which has been issued by a state of Michigan issuing officer of the school district, intermediate school district, public school academy or nonpublic school prior to starting work. More information: https://www.michigan.gov/leo/bureaus-agencies/ber/wage-and-hour/work-permits

Front of completed work permit *

Max. file size: 5 MB.

Back of completed work permit *

Max. file size: 5 MB.

Final Authorization and Signature

Authorization and consent for release of information *

After reading this document, I fully understand the contents and authorize Kalamazoo College to conduct a background verification. I authorize Kalamazoo College and its agents to request and receive an investigative consumer report concerning me and to investigate my background as it pertains to employment considerations. This may include investigation of employment history and performance, personal/professional references, educational history, licenses and information contained in public records including credit, criminal, driving record, motor vehicle data and worker’s compensation. I release all persons, companies, or corporations furnishing such information from liability and responsibility.

I understand and agree that: The information supplied was submitted by myself, and all information is true and correct, to the best of my knowledge. I understand that false or misleading information given in my application and/or interview(s) will be considered as cause for possible dismissal and/or discharge. I also understand that I am to abide by all rules and regulations of the company.

The company has my authorization to thoroughly investigate my work and personal history. I understand that the information supplied by me, regarding my: Employment History, Education (including an authorization to release transcripts), Credit History, Criminal History, Medical and Professional Licensing, Motor Vehicle Record(s), Residence History, and References, will be utilized as part of the processing procedure. A background check will be conducted to verify the veracity of the information submitted and will be utilized to develop information concerning my character, general reputation, personal characteristics, and mode of living. I will hold no person liable for giving or receiving information in this investigation. I hereby authorize that:

TR Information Services, an agent of Kalamazoo College, may be asked to make a thorough check of my credit history, driving history, criminal history, past employment, education, and activities. A copy of this form is as valid as the original.

I authorize and consent.

Signature