CORI Release - Minor under 18

Town Of Southbridge

41 Elm Street

SOUTHBRIDGE, MASSACHUSETTS 01550-2638

 

CORI Release for Prospective Employee Under the Age of 18

That the Undersigned, being of lawful age, does hereby acknowledge and represent that I am the lawful parent or guardian of the minor identified below and I authorize the Town of Southbridge to perform a so-called Criminal Offender Record Information background check on said minor in accordance with all applicable laws and in association with the minor’s prospective employment with the Town of Southbridge.

CAUTION:  READ BEFORE SIGNING BELOW!

 

MINOR:________________________________________________________________

                        (print full name)

 

PARENT/

GUARDIAN:____________________________________________________________

                        (print full name)

         

PARENT/

GUARDIAN:____________________________________________________________

                        (signature)

         

DATED:___________________________