Fillable 120414 Fillable Pdf 3rd Party Verification Re Background Checks (University of Dayton)

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120414 Fillable Pdf 3rd Party Verification Re Background Checks (University of Dayton)

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Last updated 12-4-14
THIRD PARTY VERIFICATION REGARDING BACKGROUND CHECKS
____________________________ (“Third-Party Entity”) wishes to host a program on
the University of Dayton (“University”) campus that involves minors, and this program will
involve overnight stays.
Under its Minors on Campus and Working with Children Policy and Background Check
Policy, the University requires adults who are involved in the overnight-stay component of a
minors program on campus to successfully complete, annually, a background check. The
University’s background checks search county criminal records, federal criminal records, the
national criminal database, and the sex offender database, for information regarding, among
other things, felonies, sexual offenses, drug offenses and incidents involving violence.
This document verifies that Third-Party Entity has in place a background-check protocol
that searches the same databases as does the University’s background check process. This
document further verifies that the individuals listed on Attachment A to this document, who are
employed by or otherwise affiliated with Third-Party Entity, have successfully completed
background checks on the date(s) indicated, i.e., each background check indicated no criminal
convictions and no other incident(s) that would be considered problematic by the University for
individuals working with children. Third-Party Entity hereby agrees to bear all consequences for
providing false or inaccurate information on this form, including but not limited to indemnifying
and holding harmless the University, its officers, agents, students and employees from and
against any and all claims, demands, actions or causes of action arising from any
misrepresentation contained in this document. This document is being signed by an individual
with knowledge of the matters stated herein and authority to bind Third-Party Entity.
Signed and verified on behalf of _____________________________:
Signature: ________________________
Printed name: _____________________
Title: ____________________________
Date: ____________________________
THIRD-PARTY ENTITY
THIRD-PARTY ENTITY
Verification, p. 1 of 1
Print Form
Last updated 12-4-14
ATTACHMENT A TO
THIRD-PARTY VERIFICATION REGARDING BACKGROUND CHECKS
Each listed individual below, who is employed by or otherwise affiliated with
____________________________, has successfully completed a background check on the date
indicated, as a “successful background check” is further specified in the Third-Party Verification:
NAME OF INDIVIDUAL (FIRST AND LAST)
DATE OF BACKGROUND CHECK
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
THIRD-PARTY ENTITY
Attachment A to Verification
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120414 Fillable Pdf 3rd Party Verification Re Background Checks (University of Dayton)

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Completed 21 July 2020

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