UNITED INDEPENDENT SCHOOL
DISTRICT
Human Resources Department
201 Lindenwood Dr., Laredo, Texas 78045 (956) 473-6273; (956) 473-6303
Fax
CRIMINAL HISTORY RECORD
INFORMATION AUTHORIZATION FOR
STUDENT TEACHERS AND VOLUNTEERS
The United Independent School District is required by the Texas Education Code Chapter 22, Subchapter C to review the criminal
history of applicants, employees, independent contractors, student teachers and volunteers. The information requested below is
necessary to obtain criminal history.
I authorize the United Independent School District to obtain copies of any information pertaining to any criminal history
rec
ord
maintained by any law enforcement agency and to use said information for the purpose of evaluating my application for
volunteering.
In order to obtain a criminal check you must be 18 years or older
PERSONAL
INFOR
M
A
T
I
O
N
Legal
Name:
Date
of
Birth:
/
/
First Name Middle Last Month/Day/Year
Address:
City:
State:
Zip
Code:
Sex:
Male/Female
Driver’s
License
Number/State
Issued:
Moral turpitude is an act of baseness, vileness or depravity in the private or social duties outside the accepted standards
o
f decency
and that shocks the conscience of an ordinary person, including, but not limited to theft, murder, rape, swindling and
indece
ncy with
a minor.
Yes No Have you ever been arrested?
*An arrest is not an automatic bar to volunteering. The district will consider the nature and date of the offense,
and the relationship between the offense and the volunteer position for which you are applying.
If yes, pl
ease attach a statement of the nature of the offense.
Yes No Have you ever been convicted of, pled guilty or no contest (nolo contendere) to, or received probation,
suspension, or deferred adjudication for a felony or any offense involving moral turpitude (including, but not
limited to theft, rape, murder, swindling, and indecency with a minor)?
If yes, please attach a statement of the nature of the offense.
Yes No Have you ever been charged with, been convicted of, received deferred adjudication (probation), pled guilty or
nolo contendere for an offense or capital murder, attempted murder, murder, voluntary manslaughter,
involuntary manslaughter, indecency with a child, injury to a child or elderly or disabled individual, kidnapping,
deadly weapon was used or exhibited or for any felony related to the manufacture, delivery or possession of
marijuana, a controlled substance, or dangerous drug? “Conviction” shall include probation or deferred
adjud
ication (probation), a finding of guilt or acceptance by the court of a plea of guilty, or nolo
contender
e review
each application according to the criteria set forth in the district’s DC (Local) policy.
Volunteer/Student
Teacher
Signature:
Date:
Parent’s
Signature:
Date:
(Required if intern is under 18 yrs. of age or a current U.I.S.D. student)
Sec. 22.0835. Access to Criminal History Records of Student Teachers and Volunteers by Local and Regional Education Authorities.
(a) A School district, open-enrollment charter school, or shared services arrangement shall obtain from the department and may obtain from any other law
enforcement or criminal justice agency or a private entity that is a consumer reporting agency governed by the Fair Credit Reporting Act (15 U.S.C. Section
1681 et seq.), all criminal history record information that relates to: (1) a person participating in an internship consisting of student teaching to receive a
teaching certificate; or (2) a volunteer or person who has indicated, in writing, an intention to serve as a volunteer with the district, school, or shared
services arrangement. (c) A person to whom Subsection (a) or (b) applies must provide to the school district, open-enrollment charter school, private
school, regional education service center, or shared services arrangement a driver’s license or another form of identification containing the person’s
photograph issued by an entity of the United States government.
UISD Form 903-050,
04-2019
click to sign
signature
click to edit
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click to sign
signature
click to edit
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