Morris Plains the Community of Caring
531 Speedwell Ave, Morris Plains, NJ 07950     973-538-2224

Background Consent Form

Background Check

Fingerprint and Background Check Consent Form for Employees, Job Applicants and Volunteers that may work with or have contact with minors

Morris Plains logol

In accordance with Borough of Morris Plains and N .J .S.A. l 5A:3A-1 et seq, I understand that, as a condition
of continued employment, new employment, or my volunteer service, the Borough of Morris Plains requires
background checks on all individuals who will be working with children.
By signing this form, I agree to be fingerprinted and consent to a criminal background record check as a
condition of new employment, continued employment, or voluntary service. I also represent, attest, and
certify that I have never been convicted of any of the following crimes or disorderly persons offenses as
defined by New Jersey law or the law of any other state, or that the guilty disposition of any of the crimes
and/or offenses has been amended to a status of not guilty, or that any previous charges, as listed below, have
been expunged:

2C: 11 HOMICIDE
all offenses

2C:12 ASSAULT, ENDANGERING, THREATS
all offenses

2C: 13 KIDNAPPING
all offenses

2C:I4 SEXUAL OFFENSES
all offenses

2C:15 ROBBERY
all offenses

2C:20 THEFT
all offenses

2C:24 OFFENSES AGAINST THE FAMILY, CHILDREN AND INCOMPETENTS
all offenses

2C:35 CONTROLLED DANGEROUS SUBSTANCES

all offenses except paragraph (4) of subsection a. ofNJS.2C:35-10

Name(Required)
Program or Advisory Board Requesting Background Check(Required)
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