KUSD Background Check Form

Criminal Information Records Check Permission Form

If you are a new volunteer, please complete the entire background check form and make sure to submit.  If you are a returning RAL tutor, background checks are valid for 2 years.  If it has been more than 2 years, you will need to complete a new background check

Please note, if you are a new volunteer we cannot consider your application without the Readers Are Leaders Volunteer Kindergarten Tutor Application.  

The information required within this background check form is secure and is required on any persons who have District approved access to children in supervised or unsupervised settings before they will be allowed to come into contact with students.  This includes, but is not limited to, chaperones, volunteers, tutors, mentors, and independent contractors.  It is confidential and will not be used for any other purposes. 

By completing this background check form, you agree to permit Kenosha Unified School District to perform a Criminal Information Records Check. You are releasing United Way of Kenosha County and the District and agents and all persons, agencies, and entities providing information or reports about you from any and all liability arising out of the mentioned information or reports. 

For more information on the Kenosha Unified School Districts' Board of Education Policy, please refer to Policy 4332.  If you have any questions, please contact us at unitedway@kenoshaunitedway.org or call 262-658-4104.

Thank you.

Kenosha Unified School District School Board Policy 4332 states:

A criminal background check shall be conducted for all persons recommended for employment as administrators, teachers, other certified employees, substitute teachers, and all other non-certified employees, including but not limited to substitutes, service employees, educational assistants, secretarial/clerical staff, educational interpreters, carpenters/painters, part-time/temporary, advisors and coaching assignments.

Likewise, a criminal background check shall be conducted on any persons who have District approved access to children in supervised or unsupervised settings before they will be allowed to come in contact with students. This includes, but is not limited to, chaperones, volunteers, tutors, mentors and independent contractors. A background check may be conducted on board- or administration-appointed standing committee or ad-hoc committee members who may come into contact with students in supervised or unsupervised settings.

Information from criminal background checks will not be used or considered in making employment or volunteerism decisions unless a past conviction or circumstance giving rise to a pending charge is substantially related to the circumstances of the particular job/position applied for.

Under the principle of federal supremacy and in accordance with the provisions of federal law requirements, all applicants recommended for employment with federally funded Head Start positions shall be required to disclose information regarding all prior arrests, in addition to convictions and pending charges.
I agree to permit the Kenosha Unified School District to perform a Criminal Information Records Check. I understand that my appointment to a position, my ability to participate as a District volunteer/chaperone, and/or my agreement to perform services as an Independent Contractor in the District will depend upon the results of the Criminal Information Records Check, in accordance with the Kenosha Unified School District Board Policy and the Office of Human Resources. I also understand that the District will not be responsible for any loss or damage to my personal property.