Online CORI Form

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Online CORI Form

Please show your Government Issued ID (Driver License) to any Board Member and we will be able to check your name off to coach for the season. Thank you in advance for your time!

CRIMINAL OFFENDER RECORD INFORMATION (CORI)
ACKNOWLEDGEMENT FORM

TO BE USED BY ORGANIZATIONS CONDUCTING CORI CHECKS FOR EMPLOYMENT, VOLUNTEER,
SUBCONTRACTOR, LICENSING, AND HOUSING PURPOSES.

Weymouth Street Hockey League, Inc. 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 Weymouth Street Hockey League, Inc. 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:

Weymouth Street Hockey League, Inc. may conduct subsequent CORI checks within one year of the date this form was signed by me provided, however, that Weymouth Street Hockey League, Inc. must first provide me with written notice of this check.

Email Address *

First Name *

Last Name *

What team are you volunteering for? *

k-1 Weymouth Cal Ripken Maroon

k-1 Tullish and Clancy Real Estate Royal Blue

k-1 Abby Tellier Real Estate-Coldwell Banker Antique Irish Green

k-1 Snip-it’s Haircuts For Kids Pink

k-1 Fred Happle Councilor-at-Large Black

k-1 Senator Patrick O'Connonr Sport Grey

k-1 Dairy Queen Red

k-1 Weymouth Little League Electric Green

k-1 Thompson Insurcance and Financial Services Carolina Blue

k-1 Boston Brick Co Tennese Orange

2 & 3 Herbies Sport Grey

2 & 3 Manet Contracting Royal Blue

2 & 3 W. J. Burns CPS Red

2 & 3 CeCe's Pizza Electric Green

2 & 3 The Cottage Antique Irish Green

2 & 3 Warrens Place Maroon

2 & 3 Represntative James Murphy Lime Green

2 & 3 Coastal Heritage Bank Tennese Orange

2 & 3 Joe Cushmans Sportswear Carolina Blue

2 & 3 Speaker Ron Marino Black

4/5/06 Heidi's Skin Care Neon Blue

4/5/06 Jimmy's Broad Street Diner Carolina Blue

4/5/06 Park Ave. Market Lime Green

4/5/06 Pour Yard Sport Grey

4/5/06 Throne Depot Tennese Orange

4/5/06 Weymmouth Police Royal Blue

4/5/06 Laxachusetts Maroon

4/5/06 PFM Red

4/5/06 Raymond Realtors Electric Green

4/5/06 Kaczmarczyk - Real Estate Yellow

4/5/06 Barber Home Inspection Antique Irish Green

4/5/06 Liberty Bay Credit Union Purple

7-8-9-10 Crossroads Black

7-8-9-10 The Mayors Maroon

7-8-9-10 McGavins Antique Irish Green

7-8-9-10 Weymouth Fire Red

7-8-9-10 Baileys Deli Royal Blue

7-8-9-10 IBEW Local 103 Carolina Blue

Champions Coops Troop Purple

Champions Tanner B Orange

Date of Birth *

YYYY

Last SIX Digits of Your Social Security Number *

Just the last 6 Digits

By signing below, I provide my consent to a CORI check and acknowledge that the information provided on this Acknowledgement Form is true and accurate. *

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