CRIMINAL OFFENDER RECORD INFORMATION (CORI)
ACKNOWLEDGEMENT FORM
Th
e Town of Foxborough is registered under the provisions of M.G.L. c. 6, § 172
to receive CORI for the purpose of screening current and otherwise qualified
prospective employees, subcontractors, volunteers, license applicants, current
licensees, 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 the Town of Foxborough 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 written notice of my intent to withdraw consent to a CORI check.
FOR EMPLOYMENT, VOLUNTEER, AND LICENSING PURPOSES ONLY:
The Town of Foxborough
may conduct subsequent CORI checks within one year
of the date this Form was signed by me provided, however, that the Town
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.
___________________________________ _________________________
SIGNATURE DATE
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