Approval is based on the results of a criminal background check performed using the information you provide below. All mentors must speak with the mentor organization (Mentors Care or Heart & Home) before submitting this application. Call 214-276-5839 if you need more information.

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* 1. Contact Info (as written on ID)

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* 2. Date of Birth

Date

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* 3. Driver's License or Government Issued ID #

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* 4. What state issued this ID?

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* 5. Current Contact Info

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* 6. Other names used (if applicable):

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* 7. Have you ever been charged, plead guilty, or convicted of a felony?

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* 8. If yes, please describe

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* 9. Which option best describes your role at AA? (pick 1 option only)

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* 10. Campus(es)

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* 11. Preferred Days (Check all that apply)

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* 12. Preferred times

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* 13. Spouse Name (If Spouse is an Advantage Academy Employee)

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* 14. Do you have a current child/grandchild/family member/foster attending AA?

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* 15. Are you able and willing to chaperone student field trips?

STATEMENT OF ACCEPTANCE AND AUTHORIZATION

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* 16. I have carefully read and understand this application and authorization. By selecting YES below, I certify the information I provided on this application is true and correct to the best of my knowledge. I understand that any information found to be intentionally withheld or fraudulent, will result in a denial of my application. I agree that this application and authorization in original, faxed, photocopied or electronic form will be valid for any reports that may be requested by or on behalf of Advantage Academy. I understand that the criminal history information obtained by Advantage Academy and its representatives will not be released or disclosed to any person(s) and that such record(s) will be considered CONFIDENTIAL. I also understand that I may withhold my permission and that in such a case, no investigation will be done, and my application will not be processed further.

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* 17. Signature (type full name)

Activities and duties shall be at the discretion and direction of Campus Administration with proper notification. Advantage Academy reserves the right to decline the activities, participation, or services of anyone for any reason without cause or notice.

By clicking the SUBMIT button below, I hereby consent and authorize Advantage Academy, its designated agents, and representatives to conduct a comprehensive review of my background and for an investigative report to be obtained for the purposes of evaluating whether I qualify for the school volunteer role for which I am applying. I understand that the scope of the review may include, but is not limited to the following areas: verification of social security number; current and previous residences; civil and criminal history records from any criminal justice agency in any or all federal, state, or county jurisdictions.

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* 18. In order to receive approval, please attach a photo copy of your drivers license or government issued ID.

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NOTE:  In order for this application to be processed, you must click next to go to the next page. The next page is a TX DPS CCH Verification form which authorizes Advantage Academy to perform a criminal history background check. The next form is required by state law and is required to process your application. If not completed you will be required to submit a new application again.

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