Criminal Offender Record Information (CORI) Acknowledgment Form

The Hampden County Sheriff’s Department is registered under the provisions of M.G.L. c.6, § 172 to receive CORI for the purpose of screening current and otherwise qualified prospective volunteers. As a prospective or current volunteer, I may be working with youth from the community; I understand that a CORI check will be submitted for my personal information to the DCJIS. I hereby acknowledge and provide permission to the Hampden County Sheriff’s Department to submit a CORI check for my information to the DCJIS. This authorization is valid for one year from the date of my signature. I may withdraw this authorization at any time by providing the Hampden County Sheriff’s Department with written notice of my intent to withdraw consent to a CORI check.

FOR VOLUNTEER, PURPOSES ONLY:

The Hampden County Sheriff’s Department may conduct subsequent CORI checks within one year of the date this Form was signed by me, provided, however, that the Hampden County Sheriff’s Department must first provide me with written notice of this check. By signing below, I provide my consent to a CORI check and affirm that the information provided within this Acknowledgement Form is true and accurate.