Background checks

Swing Education & Chicago Public Schools

Below are the forms and directions for completing your background checks with Swing Education and Chicago Public Schools. Please look at the yellow highlights and fill out accordingly.

Step 1

Print completed forms and take them to Accurate Biometrics. You can either fill out the yellow sections prior to printing by downloading as a PDF, or by printing first and then filling out all highlighted sections.

Step 2

Once both background checks are complete, upload the receipts to your Swing account. See examples of what these receipts look like below.

State of Illinois Department of Children and Family Services

AB-DCFS-2019

AUTHORIZATION FOR BACKGROUND CHECK Child Abuse and Neglect Tracking System (CANTS) For Programs NOT Licensed by DCFS

NOTE: Do not use this form if you are an applicant for licensure or an employee/volunteer of a licensed child care facility. Please contact your licensing representative.

I hereby authorize the Illinois Department of Children and Family Services to conduct a search of the Child Abuse and Neglect Tracking system (CANTS) to determine whether I have been a perpetrator of an indicated incident of child abuse and/or neglect or involved in a pending investigation. I further consent to the release of this information to the agency listed below.

773-553-3020 (Submitting Agency Fax Number)

dcfscpschecks@cps.edu (Submitting Email Address)

Release and Consent to Conduct and Disclose Background Investigation and Personnel Information

This form gives the Board of Education of the City of Chicago ("Board") authorization to conduct a Background Investigation which may include, but is not limited to, a Fingerprint-based Criminal History Records Check and an Illinois Department of Children and Family Services State Automated Child Welfare Information System check (collectively, "Background Investigation"). This form also gives the Board authorization to release all information or documentation regarding any disciplinary or dismissal actions taken against you during your employment by the Board and your current eligibility for rehire by the Board and, if ineligible for rehire, the reasons therefore (collectively, "Personnel Information"). You must have a valid, unexpired government-issued or school-issued photo ID at the time of fingerprinting.

Authorizing Manager or Supervisor Information

First and Last Name: Quiana Jones
Title or Position: Director of Human Resources
Charter School Name: Noble Schools (the "Charter School")
Address: 1 N. State Street
Contact Number: (312)835-9852
Email: qjones@nobleschools.org
School ORI #: CPS (Charter) ORI # ILL15105S

I, the undersigned, authorize the person listed below to complete fingerprinting to work with my Charter School.
Signature:
Date: 7/10/2023

Employee/Vendor/Volunteer (Applicant) Information

Position Title: Swing Education Substitute Teacher
Circle one: Employee Volunteer Vendor
Last Name: __
First Name: __
Middle Initial: __
Address: __
Number Street City State Zip:
Email: __
Day Phone: (___)

Date of Birth: __
Sex: □ Male □ Female
Race: __
MM/DD/YY
Height: __
Weight: __ lbs.
Eye Color: __
Hair Color: __
Ft. In.:
Social Security Number: __ - __ - __
Birth Place: __
City State

Race Key:
C = Caucasian
H= Hispanic
B = Black/African American
A= Asian/Pacific Islander
I = Native American/Alaskan
U = Unknown

Ill15105S Charter School

Rev07012023

If you currently reside in Illinois, please list all previous addresses for the past five years OR if you currently reside out-of-state, please provide ALL Illinois addresses in which you did reside while living in Illinois. Check box if no other addresses. (Street/Apt#/City/County/State/Zip Code)
Dates From/To
(1) ____ ____
(2) ____ ____
(3) ____ ____
(4) _____ _____

List maiden name and/or all other names by which you have been known (Last, First, Middle). Check if not applicable. (1) ____
(2) ____
(3) ____
(4) ____

REQUIRED CRIMINAL AND CHILD ABUSE RECORDS DISCLOSURE: The existence of a criminal or child abuse record does not automatically disqualify you for employment consideration or continued employment, unless it is a conviction or adjudication for an enumerated offense. (Please see the back of this form for a listing of enumerated offenses.) If you have a criminal or child abuse record that does not involve an enumerated offense, it is important that the Charter School and the Board know your complete criminal and child abuse history to properly evaluate your application or fitness for continued employment. You must disclose it in full. Failure to disclose each conviction and child abuse adjudication may result in disqualification of your application or termination of employment.

Convictions include all felony or misdemeanor convictions, whether by pleas of guilty, nolo contendere, or no contest or after bench or jury trial. Convictions that result in sentences of probation, conditional discharge, or imprisonment must be reported. Convictions of driving while intoxicated or under the influence ("DUI"), and driving on a revoked or suspended license must be reported. But convictions that resulted in sentences of supervision in Illinois or traffic offences other than DUI or driving on a revoked or suspended license should not be reported (i.e., speeding tickets, running a red light or stop sign, driving without insurance, etc.). Finally, you are not obligated to disclose sealed or expunged records of conviction or arrest.

Have you ever been convicted of any type of crime?
Yes No

Have you ever been adjudicated the perpetrator of sexual or physical abuse in a juvenile court proceeding or had an Illinois Department of Children and Family Services' "indicated" finding?

Yes No

If yes, describe each conviction and adjudication below (attach separate sheets if necessary):

Ill15105S Charter School

Rev07012023

REQUIRED SEXUAL MISCONDUCT DISCLOSURE: For purposes of the three questions below, the term “sexual misconduct,” as defined in 105 ILCS 5/22-85.5 (sexual misconduct), means any act, including, but not limited to, any verbal, nonverbal, written, or electronic communication or physical activity that (1) you committed as an employee or agent of a school district, charter school, or nonpublic school during which time you engaged in or had the possibility of engaging in the care, supervision, guidance, or control of or routine interaction with students; and (2) was directed toward or with a student to establish a romantic or sexual relationship with the student. Such an act includes, but is not limited to:

1. A sexual or romantic invitation;
2. Dating or soliciting a date;
3. Engaging in sexualized or romantic dialog;
4. Making sexually suggestive comments that were directed toward or with a student;
5. Self-disclosure or physical exposure of a sexual, romantic, or erotic nature; and
6. A sexual, indecent, romantic, or erotic contact with the student.

1. Have you ever been the subject of an allegation of sexual misconduct?

Note: Check “No” if an investigation resulted in a finding that the allegation was false, unfounded, or unsubstantiated.
[] Yes [] No

2. Have you ever been discharged from, been asked to resign from, resigned from, or otherwise been separated from any employment; been disciplined by an employer; or had an employment contract not renewed due to an adjudication or finding of sexual misconduct, or while an allegation of sexual misconduct against you was pending or under investigation?
   Note: Check “No” if an investigation resulted in a finding that the allegation was false, unfounded, or unsubstantiated.
   [] Yes [] No

3. Have you ever had a license or certificate suspended, surrendered, or revoked; or had an application for licensure, approval, or endorsement denied due to an adjudication or finding of sexual misconduct or while an allegation of sexual misconduct against you was pending or under investigation?
   Note: Check “No” if an investigation resulted in a finding that the allegation was false, unfounded, or unsubstantiated.
   [] Yes [] No

AUTHORIZATION TO DISCLOSE RESULTS OF BACKGROUND INVESTIGATION AND PERSONNEL INFORMATION TO THE CHARTER SCHOOL

I, the undersigned, hereby authorize the release of any criminal history record information that may exist regarding me from any agency, organization, institution, or entity having such information on file. I am aware and understand that my fingerprints may be retained and will be used to check the criminal history record information files of the Illinois State Police and/or the Federal Bureau of Investigation, to include but not limited to civil, criminal and latent fingerprint databases. I also understand that if my photo was taken, my photo may be shared only for employment or licensing purposes. I further understand that I have the right to challenge any information disseminated from these criminal justice agencies regarding me that may be inaccurate or incomplete pursuant to Title 28 Code of Federal Regulation 16.34 and or Chapter 20 ILCS 2630/7 of the Criminal Identification Act.

I, the undersigned, provide this authorization to the Board, in connection with my application to work or my continuing to work with the Charter School.
I also authorize the Board to release and disclose the results of the Background Investigation and Personnel Information to the Charter School. I understand that the purpose of this authorization is to enable the Charter School to make a complete assessment of my fitness to work with the Charter School.

I, the undersigned,

1. acknowledge and verify that all information provided above is true and accurate and that I am the person named above;
2. supply this information to authorize and enable the Board to perform a background investigation, which may include, but is not limited to, a Fingerprint-based Criminal History Records Check;
3. understand and agree that the information obtained through the Background Investigation and Personnel Information check will be used to determine whether employment by the Charter School will be offered or continued or whether volunteer or compensated service will be approved;
4. acknowledge that the Charter School exclusively makes the decision on whether to offer or continue my employment or volunteer services

Ill15105S Charter School

Rev07012023

5. authorize the Illinois Department of Children and Family Services to conduct a search of the State Automated Child Welfare Information System ("SACWIS") to determine whether I have been "indicated" as a perpetrator of child abuse and/or neglect or am the subject of a pending investigation; and,

6. waive provisions of the Illinois Personnel Records Review Act regarding notices to me and deletion of records more than 4 years old, and authorize the Board to release any and all Personnel Information.

7. Understand and consent to the reprocessing of my fingerprints or other criminal history verification at regular periodic intervals throughout the duration of my time working with charter/contract/alternative schools and to review any criminal or child-abuse-and-neglect history pursuant to the Illinois School Code.

RELEASE OF CLAIMS AGAINST THE CHARTER SCHOOL AND THE BOARD

I hereby release, hold free and harmless, and discharge the CHARTER SCHOOL and the BOARD, their members, officers, employees, agents, and contractors from any and all claims, causes of action, liabilities, losses, costs and expenses that may arise (solely or in part) as a result of the Board's release and disclosure of the results of my Background Investigation and/or Personnel Information to the Charter School.

Signature:

Date:

INTERNAL CPS USE ONLY

Privacy Act Statement

Authority: The FBI’s acquisition, preservation, and exchange of fingerprints and associated information is generally authorized under 28 U.S.C. 534. Depending on the nature of your application, supplemental authorities include Federal statutes, State statutes pursuant to Pub. L. 92-544, Presidential Executive Orders, and federal regulations. Providing your fingerprints and associated information is voluntary; however, failure to do so may affect completion or approval of your application.

Principal Purpose: Certain determinations, such as employment, licensing, and security clearances, may be predicated on fingerprint-based background checks. Your fingerprints and associated information/biometrics may be provided to the employing, investigating, or otherwise responsible agency, and/or the FBI for the purpose of comparing your fingerprints to other fingerprints in the FBI’s Next Generation Identification (NGI) system or its successor systems (including civil, criminal, and latent fingerprint repositories) or other available records of the employing, investigating, or otherwise responsible agency. The FBI may retain your fingerprints and associated information/biometrics in NGI after the completion of this application and, while retained, your fingerprints may continue to be compared against other fingerprints submitted to or retained by NGI.

Routine Uses: During the processing of this application and for as long thereafter as your fingerprints and associated information/biometrics are retained in NGI, your information may be disclosed pursuant to your consent, and may be disclosed without your consent as permitted by the Privacy Act of 1974 and all applicable Routine Uses as may be published at any time in the Federal Register, including the Routine Uses for the NGI system and the FBI’s Blanket Routine Uses. Routine uses include, but are not limited to, disclosures to: employing, governmental or authorized nongovernmental agencies responsible for employment, contracting, licensing, security clearances, and other suitability determinations; local, state, tribal, or federal law enforcement agencies; criminal justice agencies; and agencies responsible for national security or public safety.

Applicant Consent

By signing below, I acknowledge and hereby authorize the release of any criminal history record information that may exist regarding me from any agency, organization, institution, or entity having such information on file. I am aware and understand that my fingerprints may be retained and will be used to check the criminal history record information files of the Illinois State Police and/or the Federal Bureau of Investigation, to include but not limited to civil, criminal and latent fingerprint databases. I also understand that if my photo was taken, my photo may be shared only for employment or licensing purposes. I further understand that I have the right to challenge any information disseminated from these criminal justice agencies regarding me that may be inaccurate or incomplete pursuant to Title 28 Code of Federal Regulation 16.34 and Chapter 20 ILCS 2630/7 of the Criminal Identification Act.

Applicant Name (printed):
Applicant Name (signature):
Date:

THIS SIGNED FORM MUST BE RETAINED BY THE AGENCY FOR AT LEAST TWO YEARS.

Enumerated Offenses in Illinois School Code, 105 ILCS 5/34-18.5, referencing 105 ILCS 5/21B-80

1. Any offense defined in the Cannabis Control Act...

(Additional enumerated offenses continue from here)

...

Swing Education

Please Provide The Following Information (Please Print Clearly).

Last Name: ___First Name: __MI
Address: __City:
State: ______________________ Zip Code: ________________
Date of Birth: _/__/_ Sex: _______ Race: _______
Height: _______ Weight: _________
Hair Color: ______________ Eye Color: ____________
Social Security Number: ___________________________________
Place of Birth: (State or Country if outside USA):___
**ORI-__
_______ (DO NOT WRITE BELOW THIS LINE – FOR OFFICE USE ONLY________
TCN#_______________________________________ Date Printed_______________________