Volunteers at Kinloch Park Middle School

MDCPS Level 1 background check questionnaire

Please take time to fill out the information below to become Level one background checked by MDCPS and participate in the Soil Preparation Event at Kinloch Park Middle School. Thank you so much for being apart of this movement to go green and enhance the local schools in our communities!

Question Title

* 1. Complete first and last name of volunteer as it appears on picture ID/ drivers license?

Question Title

* 2. Please write your full SSN?

Question Title

* 3. What is your date of birth? MM/DD/YYYY

Question Title

* 4. What is your full home address as it appears on your photo ID/ drivers license? (please include apt #, city, state, and zip code)

Question Title

* 5. What is your primary phone number?

Question Title

* 6. E-mail address?

Question Title

* 7. What is your gender?

Female

Male

Question Title

* 8. What is your Ethnicity? (Check all that apply)

Hispanic

White

Black

Asian

American Indian or Alaskan Native

Native Hawaiian or Pacific Islander

Question Title

* 9. Are you bilingual?

Yes

I understand other languages but I do not speak

I speak other languages but I do not understand

I speak and understand other languages a mildly

Question Title

* 10. Are you a grandparent?

Yes

Question Title

* 11. What is your primary language?

English

Spanish

Other

Question Title

* 12. Please give us an emergency contact person who can be reached on your behalf in the case of an emergency?

Question Title

* 13. What is your emergency contact's phone number?

Question Title

* 14. Are you an active/former member of law enforcement, firefighter, DCF employee, judge, government employee involving human resources, labor relations, and or a code enforcement officer?

Yes