"Statement of Compliance With Background Record Check Requirements" - Massachusetts

Statement of Compliance With Background Record Check Requirements is a legal document that was released by the Massachusetts Department of Early Education and Care - a government authority operating within Massachusetts.

Form Details:

  • Released on January 22, 2010;
  • The latest edition currently provided by the Massachusetts Department of Early Education and Care;
  • Ready to use and print;
  • Easy to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a printable version of the form by clicking the link below or browse more documents and templates provided by the Massachusetts Department of Early Education and Care.

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The Commonwealth of Massachusetts
Department of Early Education and Care
STATEMENT OF COMPLIANCE WITH BACKGROUND RECORD
CHECK REQUIREMENTS
This form must be completed by the Licensee or Reviewer (employer) and placed in the
employee’s personnel file when CORI and DCF Background Responses are reviewed.
NAME OF PROGRAM: ___________________________________________________
NAME OF EMPLOYEE: __________________________________________________
THIS IS TO CERTIFY THAT I HAVE RECEIVED AND REVIEWED THIS
CANDIDATE’S CORI RESULTS.
_______________________________________
____________________________
Signature of Licensee or Reviewer
Date
THIS IS TO CERTIFY THAT I HAVE RECEIVED AND REVIEWED THIS
CANDIDATE’S DCF RESULTS.
_______________________________________
____________________________
Signature of Licensee or Reviewer
Date
SG/LG/SAComplianceWithBRC20100122
The Commonwealth of Massachusetts
Department of Early Education and Care
STATEMENT OF COMPLIANCE WITH BACKGROUND RECORD
CHECK REQUIREMENTS
This form must be completed by the Licensee or Reviewer (employer) and placed in the
employee’s personnel file when CORI and DCF Background Responses are reviewed.
NAME OF PROGRAM: ___________________________________________________
NAME OF EMPLOYEE: __________________________________________________
THIS IS TO CERTIFY THAT I HAVE RECEIVED AND REVIEWED THIS
CANDIDATE’S CORI RESULTS.
_______________________________________
____________________________
Signature of Licensee or Reviewer
Date
THIS IS TO CERTIFY THAT I HAVE RECEIVED AND REVIEWED THIS
CANDIDATE’S DCF RESULTS.
_______________________________________
____________________________
Signature of Licensee or Reviewer
Date
SG/LG/SAComplianceWithBRC20100122