Background Consent Form

It typically takes a week to complete a background check.
If you are completing your application with less than a week from your event, please reach out to your contact.

Background Check

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

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 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)

First Last

Email to be used for follow up and notifications(Required)

Phone(Required)

Program or Advisory Board Requesting Background Check(Required)

Invoice # from program registration (if not associated with a registration, enter n/a)(Required)

*If Other, please describe below, including requestor's email if possible

Name of Borough program/event will you be attending(Required)

Date(s) of the Borough program(Required)

Date of Birth(Required)

Driver's License Number(Required)

Signature(Required)

Date(Required)

Background Consent Form

Background Check

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