Charter School of the Dunes Background Check Application

Dear Applicant,

We are excited for the opportunity to have you join our Charter School of the Dunes Family. Please complete and submit an application and upon approval you will receive instructions on next steps.

It is very important that the information you enter on the application matches your government issued identification card including your full legal name. It is important that you provide a valid email address so you can be notified as to the status of your application and for future communication. If you are unable to provide an email address, you use the school’s email address. All information collected on the application will remain confidential and not be shared outside the school.

If you have any questions about the application, please contact Dan Cummins @ 219.939.9690 or email dcummins@csdunes.org.

Thank you

Personal Information

Legal First Name

Address Line 1

Legal Middle Name

I don't have a middle name

Address Line 2 / Apt # / Building #

Legal Last Name

City

Maiden Name

State/Province/Region

Gender

Postal/Zip Code

Date Of Birth

Phone Number Phone number is required

Affiliation

Please note: An email will be sent to the email address entered to inform you of the status of your application. If you do not have access to email, please enter dcummins@csdunes.org and a district administrator will call you regarding the status.

Please select the schools at which you wish to volunteer

Please select the functions from the list below. (select all that apply)

Please select the organization(s) on behalf of which you are volunteering (if not applicable, select "None")

Please read the disclaimer below and provide your signature

By providing your signature, you are agreeing to abide by the rules and regulations of Charter School of the Dunes. Your employment selection will require you to submit your United States social security number so we can perform a criminal background check. Your social security number will only be used for this purpose and we do not retain this information.

Name

Signature

By signing your name you agree to all the above statements. Use the mouse or touch screen to sign.

Thank You

Your background check application has been successfully submitted and will be reviewed per Charter School of the Dunes' policy. In the near future, you will be notified as to your approval status.

If you have any questions, please request to speak with Dan Cummins via email.

Best Regards,
Dan Cummins

dcummins@csdunes.org