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CORI Authorization Form
Taunton Area Babe Ruth League, Inc. is registered under the provisions of M.G.L. c.6, ยง 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, or current licensee, I understand that a CORI check will be submitted for my personal information to the DCJIS. I hereby acknowledge and provide permission to Taunton Area Babe Ruth League, Inc. to submit a CORI check for my information to the DCJIS. This authorization is valid for three years from the date this form is submitted. I may withdraw this authorization at any time by providing Taunton Area Babe Ruth League, Inc. with written notice of my intent to withdraw consent to a CORI check.
FOR EMPLOYMENT, VOLUNTEER, AND LICENSING PURPOSES ONLY:
The Taunton Area Babe Ruth League, Inc. may conduct subsequent CORI checks within three years of the date this Form was submitted by me.
By completing and submitting this online form, I provide my consent to a CORI check and affirm that the information provided in this online Authorization Form is true and accurate.
*
Last Name:
*
First Name:
Middle initial:
Suffix:
Former Last or Maiden Name:
*
Date Of Birth - enter as MMDDYYYY:
*
Last SIX (6) Digits of SSN:
Sex:
M (Male)
F (Female)
U (Neutral)
Race:
W (White/Caucasian)
B (Black)
A (Asian)
I (American Indian)
U (Unknown or other)
*
Father's Last Name:
*
Father's First Name:
*
Mother's Last Name (Married Name):
*
Mother's First Name:
*
Mother's Maiden Name:
*
Verification ID Type:
OLN - Mass Driver's License
MAID - Mass State ID
OTHER
*
Verification ID (State DL or ID #):
IF ID Verification Type is Other - please describe:
*
Phone Number for League Communication:
*
Personal Email:
Street Address:
City:
State:
Zip Code:
* indicates required fields