CRIMINAL HISTORY BACKGROUND CHECK
The following named individual is required to consent to a criminal history background check for Inver Grove Heights
Community Schools, Independent School District 199 (ISD 199). Please print.
Full Name of Individual: _______
Last First Middle
Maiden, Previous, Alias: _______________________________________________________________________
Date of Birth:______________________________________________________ Sex (M or F):________________
I authorize the Minnesota Bureau of Criminal Apprehension to disclose all criminal history record information to
Independent School District 199, pursuant to Minn. Stat. § 123B.03 subdivision 1 as a volunteer with this district.
The expiration of this authorization shall be for a period no longer than one year from the date of my signature.
Signature of Applicant or Potential Service Provider Date
Before beginning volunteer service with Independent School District 199 we will need to process your payment for the
background check as well as receive information back from the BCA. Please bring with you the following:
1) Completed Criminal History Background check form
2) $15 payment in cash or check (payable to ISD 199) to process your background check
3) Personal identification/drivers license
You have the right to request, in writing, a copy of your background check.
If you have resided out of the State of Minnesota at any time since the age of eighteen (18), you will need to notify
district office staff when returning your background check. At this time you will be given a fingerprint form and
asked to go to our local police station where you will be fingerprinted. Please return fingerprint card to the district
office, 2990 80th St. E., Inver Grove Heights, MN 55076. Independent School District 199 will not be able to process
your background check until the fingerprint card has been returned to the District Office.
EMPLOYMENT AND SERVICES CRIMINAL HISTORY BACKGROUND CHECKS
NOTICE TO PARENTS AND GUARDIANS
The school district has adopted a policy, the purpose of which is to promote the physical, social, and psychological well-being of its students. Pursuant to
this policy, the school district shall seek criminal history background checks for all applicants who volunteer with the school district. The school district also
shall seek criminal history background checks for all individuals who are offered the opportunity to provide athletic coaching services or other
extracurricular academic coaching services to the school district, regardless of whether compensation is paid. These positions include, but are not limited to,
all athletic coaches, extracurricular academic coaches, assistants and advisors. The school district also elects to seek criminal history background checks for
other volunteers, independent contractors, and student employees.
Inver Grove Heights Community Schools
2990 80th St. E., Inver Grove Heights, MN 55076
Phone: 651-306-7823 • Fax: 651-306-7295