Hays CISD Background Check Information Request
Hays Consolidated Independent School District is required by Texas Education Code Chapter 22, Subchapter C to review the criminal history of applicants, employees, independent contractors, student teachers, and certain volunteers. The information requested below is necessary to obtain criminal history record information.
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Email *
Last Name *
First Name *
Middle Name
Please indicate in which capacity your presence in the school district would apply: *
University/College Program Contact Name *
University/College Name Affiliation
Program Contact Email Address
Location for your Assignment (campus/department) *
District Contact Name
Anticipated Start Date *
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Anticipated End Date
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Social Security Number *
State that Driver's License was Issued *
Driver's License Number *
Street Address: *
City *
State *
Zip *
Date of Birth *
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Personal Contact Phone Number *
I understand that the information I am providing will not be used to determine eligibility for employment but will be used solely for the purpose of obtaining criminal history record information.*
Electronic signature *
I understand that I am not permitted on any campus until I have been issued an approval letter. *
I am aware that I must provide the approval letter to the campus secretary on my first day. *
Confidentiality Agreement: *
I affirm that:                                                                                                                                                                                       Confidentiality is one of the cornerstones of professionalism and ethics in education. I have a responsibility to preserve the confidentiality of the students with whom I interact during the student teaching internship/observations that I have undertaken as part of my program requirement at my college/university.  I have the responsibility to protect the confidentially of the students, educators, families, and other professionals in accordance with established professional ethics, state, and federal laws. Confidential information acquired shall be safeguarded within the limits of the law from disclosure, including, but not limited to, verbal disclosure and unsecured maintenance of records or recording of an activity or presentations without appropriate releases. No information about any student, teacher, administrator, or legal guardian obtained through my participation in the student teaching internship/observations in the schools and/or other agencies will be communicated to any other person or agency as mandated by law: or there is a waiver previously obtained in writing, then such information my only be revealed in accordance with terms of the wavier. Upon completion of my student teaching internship/observation conducted through my college/university, I will maintain student and school/agency confidentiality.
Required
A copy of your responses will be emailed to the address you provided.
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