I specifically give permission in connection with my service with AmeriCorps and participation in the 100 Fold Studio AmeriCorps program; I hereby authorize the 100 Fold Studio Corps program to conduct a criminal history check on my behalf.

I understand that this check will entail all of the following:
1) National Sex Offender Public Registry (NSOPW)
2) State of Residence Repository and State of Service Repository, and
3) FBI Fingerprint Check – Official start date begins only after fingerprint cards have arrived at the 100 Fold Studio office and are processed.

Criminal History checks are completed through a government agency and/or Designated State Repository.

I understand that my ability to serve as a 100 Fold Studio AmeriCorps Member is contingent upon successful clearance for service based on the results of the criminal history check. I understand that failure on my part to consent to the review will result in the cancellation of my enrollment in the 100 Fold Studio AmeriCorps Program. Results are confidential, but may be shared with your 100 Fold Studio Program Site Supervisor, if necessary. The member is entitled to receive and review the search results, upon written request and can challenge the results if desired.

I certify that statements made by me on this form and in my enrollment paperwork are true, complete, and correct to the best of my knowledge and belief, and are made in good faith. I understand that any false statements made herein could void my eligibility to serve with the 100 Fold Studio AmeriCorps program.

Also by signing below, I certify that I have not been convicted of murder or a sex offense.

“Murder is the unlawful killing of a human being with malice aforethought. Every murder perpetuated by poison, lying in wait, or any other kind of willful, deliberate, malicious, and premeditated killing; or committed in the perpetration of, or attempt to perpetrate, any arson, escape, murder, kidnapping, treason, espionage, sabotage, aggravated sexual abuse or sexual abuse, child abuse, burglary, or robbery; or perpetrated as part of a pattern or practice of assault or torture against a child or children; or perpetrated from a premeditated design unlawfully and maliciously to effect the death of any human being other than him who is killed, is murder in the first degree. Any other murder is murder in the second degree.” (18 U.S.C. § 1111)