Criminal Offender Record Information – Acknowledgement Form

Jurisdiction: Country: USA | Province/State: Massachusetts

What is a Criminal Offender Record Information – Acknowledgement Form?

This form gives you permission to request and receive a person’s Massachusetts criminal history record. In plain terms, it is a written consent and identity verification. You use it when you plan to run a CORI check for an allowed purpose. It confirms the person understands what you will request and why. It also confirms how you will handle the information.

You complete this form before you request any CORI. You collect the person’s identity details. You verify their identity with a government ID. You state the purpose of the check, like employment, volunteer service, subcontractor work, licensing, or housing. The person signs to allow the request. Either your staff verifies the identity in person, or a notary confirms it.

Who typically uses this form?

Employers. Volunteer coordinators. Property managers and landlords. Licensing boards and professional programs. Schools and youth-serving organizations. Home care agencies and health providers. Government agencies. Nonprofits. And their consumer reporting agencies that help run background checks. If you use a consumer reporting agency, you must also meet federal disclosure and authorization rules. This form is designed to cover those needs when you ask for a Massachusetts CORI.

Why would you need this form?

Because you cannot lawfully request CORI without consent. The form documents that consent. It also shows you verified the person’s identity before making the request. It helps you follow state and federal requirements around notice, use, privacy, and retention. If you plan to rely on a consumer reporting agency, this form is a key part of your compliance file.

Typical usage scenarios include hiring or onboarding. You may use it for a job applicant, a volunteer, or a subcontractor. You may use it to screen a tenant. You may use it to support a professional license. You may also use it for periodic rescreening if your policy allows it and you disclose it to the person. In each case, the allowed purpose must match your organizational role. The form does not expand your legal access. It only records consent and identity verification.

This is not a job application or a lease. It is not a promise to hire or rent. It is not a waiver of rights. It is a focused document with one job: to authorize a lawful CORI request for a clear, limited purpose.

When Would You Use a Criminal Offender Record Information – Acknowledgement Form?

You use this form before you seek a CORI on someone. Timing matters. In hiring, you cannot ask about criminal history on an initial application. You request CORI later in the process. Many organizations wait until after an interview or a conditional offer. For a volunteer, use the form before placing the person in a role. For a subcontractor, use it before granting worksite access. For licensing, use it with the application or before renewal. For housing, use it after initial screening and before final approval.

Consider a few common examples. You run a law firm and plan to hire a file clerk. You raise the background check after the interview. You present the acknowledgement form at that stage. The applicant reviews and signs. Your staff checks their driver’s license. Once the identity is verified, you request the CORI through your screening process.

You run a youth sports nonprofit. You bring on seasonal volunteers. You add the acknowledgement form to your onboarding. You verify each volunteer’s ID at the first training. You request the CORI only after you have consent.

You manage a property with many tenants. You want to screen applicants who will share common spaces with families. You use the form after you confirm rental eligibility on non-criminal criteria. Then you request CORI. You make sure any decision uses only records you may lawfully consider.

You operate a home health agency. You contract with independent aides who enter clients’ homes. You use the form for each new subcontractor. You run the CORI before assigning a client. You also disclose that you will run an annual rescreen. You include that rescreen in the authorization, with a clear time limit.

You oversee licensing for a skilled trade. Applicants complete the form with their license application. Your staff verifies each identity. You run CORI on the applicants and certain renewal candidates as required.

If you use a consumer reporting agency, you also need a standalone disclosure and authorization. Many organizations combine that disclosure with this acknowledgement in one document. That keeps the authorization clear, separate, and easy to understand.

Legal Characteristics of the Criminal Offender Record Information – Acknowledgement Form

This form is legally meaningful. It documents the person’s written consent for a CORI request. Consent is a core requirement under Massachusetts law. Consent also supports federal rules when a consumer reporting agency is involved. The form also proves you verified identity against a government-issued photo ID. That identity check helps prevent mismatched or misused records.

Is the form legally binding?

It is binding to the extent it authorizes you to request and receive CORI for the stated purpose. It does not bind the person to work for you or rent from you. It does not waive their rights. It does not justify any use beyond what state law allows. It is best seen as a permission slip with safeguards.

What ensures enforceability?

Clarity. The form must be clear, simple, and separate from other terms. Avoid confusing language. State the purpose plainly. Name the organization requesting the CORI. If you use a consumer reporting agency, identify it as well. Explain that you may rely on the records in your decision. Explain the person’s rights to see the records and dispute errors. Include a checkbox for the person to request a copy of the report. Confirm that you will keep the data confidential.

Proper identity verification supports the process. Your verifier must see a government-issued photo ID. That may be a driver’s license, state ID, or passport. Record the ID type and expiration date. Do not over-collect. You generally need the person’s full name, date of birth, current address, and the last four to six digits of their Social Security number. Collect only what you need to match records and verify identity.

Compliance practices also support enforceability. You must register for access or work through a qualified consumer reporting agency. You must limit requests to allowed purposes. You must request only the level of access tied to your role. Do not request deeper access than your role permits. You must maintain confidentiality and secure storage. Keep the signed form for the required retention period. Destroy it when that period ends.

You must also follow adverse decision rules. If you might make a negative decision based on CORI, you must provide the person with a copy of the record and your policy before you finalize your decision. You must give a reasonable time for the person to dispute the accuracy or context. Document your decision process. Use only records you may lawfully consider. Do not rely on sealed, expunged, or otherwise protected information. Follow any look-back limits and role-based filters that apply to your organization.

Do not add liability waivers to this form. Do not bundle it with other agreements. Do not add disclaimers that conflict with rights under state or federal law. The form should be short, focused, and easy to understand. If you plan periodic rescreens, say so. State the frequency and duration of the authorization. Many organizations limit authorization to one year, or the term of service, whichever is shorter.

Finally, remember that the form does not expand your legal access. It records consent. It does not change what you may ask for, receive, or use. You still must comply with all limits on access, content, and decision-making. Keep those limits front and center in your policies and training.

How to Fill Out a Criminal Offender Record Information – Acknowledgement Form

Follow these steps. Build a consistent process. Train your staff. Keep your records clean and secure.

1) Identify the requesting organization and purpose

• Enter your organization’s legal name and address. Add a direct contact name, phone, and email.
• State your role and purpose: employment, volunteer, subcontractor, licensing, or housing.
• If you use a consumer reporting agency, list its legal name and contact info. Note that the agency will obtain and deliver CORI to you for your stated purpose.

2) Confirm the subject of the CORI request

• Record the person’s full legal name. Include middle name. If none, write “No middle name.”
• List all other names used. Include former names and nicknames used in official records.
• Enter date of birth. Use the full month, day, and year.
• Enter current address, including unit number and ZIP code.
• If your process needs it, add prior addresses for the last five years. This helps avoid mismatches when names are common.
• Collect the last four to six digits of the Social Security number, if available. This helps match records. Do not require the full number unless your policy and law allow it.

3) Choose the identity verification method

• In-person verification: A trained staff member views a valid government-issued photo ID. Examples include a driver’s license, state ID, or passport. The verifier confirms the photo matches the person. The verifier records the ID type, issuing authority, ID number (only if needed), and expiration date. The verifier signs the verifier section.
• Remote notarization: If in-person is not possible, a notary may verify identity. The person signs in front of a notary. The notary completes the notary section, including the notarial certificate and stamp. Follow all rules for remote or electronic notarization if you use it.

4) Present the authorization and acknowledgements

• Use clear language. Confirm that the person authorizes your organization and, if applicable, your consumer reporting agency to request and receive Massachusetts criminal offender record information for the stated purpose.
• State that you may use the information to make decisions about employment, volunteer service, subcontractor work, licensing, or housing, as applicable.
• State that you will keep the information confidential and secure, and share it only with staff who have a need to know.
• State that the authorization lasts for a defined period. Example: for this screening only, or for this screening and periodic rescreens for up to one year. If you plan periodic rescreens, state the frequency, such as annually.
• Include a statement of rights. Confirm that if you may take an adverse action based on CORI, you will first provide a copy of the record and your policy to the person and allow time to dispute accuracy.
• Include a checkbox for the person to request a copy of any CORI you receive. Include a space for their preferred delivery method: email or mail.
• Avoid any waiver of rights or release of liability. Keep the form focused on consent and identity verification.

5) Obtain the person’s signature and date

• The person reads the form and signs. They print their name below the signature line. They date the form.
• If you use electronic signatures, use a system that captures date, time, and identity evidence. Keep the certificate with your records.

6) Complete the verifier or notary section

• If in-person verification: Your verifier prints their name and title. They enter your organization’s name and business address. They fill in the ID details they saw, including the ID type and expiration date. They sign and date the section.
• If notarized: The notary completes the notarial certificate. The certificate must name the person, the date, and the type of identification relied upon. The notary signs and affixes their stamp.

7) Add end-user and agency certifications (if using a consumer reporting agency)

• Add a short certification by your organization. Confirm that you are requesting CORI for a permissible purpose and will use it only for that purpose. Confirm you will not use prohibited records. Confirm you will provide the required notices before any adverse action.
• Add a short authorization for the agency to request CORI on your behalf. Make sure the authorization matches the identity details provided by the person.
• If your organization must have a written CORI policy, attach it to the packet. Provide it to the person upon request and before any adverse decision.

8) Review the form for completeness

• Check that names and dates match the ID.
• Confirm that the purpose is checked and clearly stated.
• Confirm that the person signed and dated.
• Confirm that the verifier or notary section is complete and signed.
• If the person requested a copy, confirm contact details for delivery.

9) Store, transmit, and destroy securely

• Keep the original form in a secure file. Limit access to trained staff.
• Transmit copies to your consumer reporting agency through a secure portal or encrypted email. Avoid fax or unencrypted email if you can.
• Retain the signed form for the required period. Many organizations keep it for at least one year after the request or decision. Follow your policy if it is longer.
• Destroy the form securely when the retention period ends. Use shredding or secure electronic deletion.

10) Use the results lawfully and fairly

• If the CORI shows records, compare them to your written standards. Consider the nature of the offense, the age of the record, and the job or housing duties. Focus on business necessity and safety.
• Remove any records you may not consider under state rules. Exclude sealed, expunged, or protected matters.
• If you may deny based on the record, pause. Provide the person with a copy of the CORI and your policy. Invite them to explain or dispute. Allow a reasonable response time.
• Document your final decision and the reasons. Keep this documentation secure.

Practical tips to avoid delays:

• Ask the person to list all names used. Missing a former surname is the most common cause of mismatches.
• Verify that all dates are in the correct format. Use two-digit months and days if your system requires them.
• If a driver’s license has expired, ask for another valid ID. Do not proceed with an expired ID.
• If you plan periodic rescreens, include that in the authorization now. Do not assume a one-time consent covers future checks.
• If you use a consumer reporting agency, submit the form and any required attachments together. Incomplete packets slow the process.

Real-world example:

You are onboarding a property maintenance subcontractor who will enter occupied units. You schedule an in-person meeting. You present the acknowledgement form and explain that it authorizes a Massachusetts CORI check for subcontractor access. The subcontractor lists their legal name, date of birth, current address, and former married name. They check the box asking for a copy of any report. Your office manager verifies a valid state ID and signs the verifier section. You upload the form to your secure portal for your screening agency. The results return in two days. One item appears that may relate to job duties. You send the subcontractor a copy of the record and your policy. You invite their response within five business days. The subcontractor provides court documents showing the case was dismissed. You confirm the dismissal and proceed with onboarding. You document the process and retain the records for your policy’s retention period.

Another example:

You run a health nonprofit and recruit volunteers for a children’s program. You hold a training day and verify each volunteer’s identity on site. Each volunteer signs the acknowledgement form. You submit the forms and receive results. One volunteer’s record includes an offense unrelated to the role and older than your look-back period. You remove it from consideration and approve the volunteer. By applying your policy consistently, you reduce risk and respect privacy.

When you use this form well, you speed up screening and protect everyone’s rights. You reduce errors and avoid disputes. You also give yourself a clear record of consent and verification, which helps you stay compliant and confident in your decisions.

Legal Terms You Might Encounter

• Criminal Offender Record Information (CORI) means records about criminal cases that happened in Massachusetts courts. When you sign this form, you allow a screening company or authorized organization to request your Massachusetts criminal history for a specific purpose, like employment, volunteering, subcontracting, licensing, or housing.
• Acknowledgement and Authorization is your written permission. It confirms you understand what records may be requested, who will receive them, and why. Without your signed authorization, the organization cannot ask for your CORI through a screening process.
• Consumer Reporting Agency is the background screening company that collects and reports information to the organization. In this process, it requests your CORI, verifies the identity details you provided, and returns a report. Your form authorizes this company to act for the requesting organization.
• Permissible Purpose is the reason the organization can request your CORI. Common purposes are employment, volunteer service, subcontracting, licensing, or housing. Your form should state the purpose. If the reason changes, a new authorization may be needed.
• Identity Verification is how your identity is confirmed before a CORI search is run. You may be asked to show a government ID or provide your full legal name, any former names, date of birth, and the last four digits of your Social Security number. This helps prevent mistakes and mismatches.
• Adverse Action means an unfavorable decision based on information in a background report. Examples include not hiring, not placing you, or denying a license or housing. If your CORI report may lead to an adverse action, you should get notice, a copy of the report, and a chance to dispute inaccuracies before a final decision.
• Sealed or Expunged Records are cases that are legally hidden or removed from public view. Depending on your situation, these records may not appear in a CORI check, or the organization may be prohibited from asking about them. Your form does not require you to reveal records that are not legally disclosable.
• Limited Access/Need-to-Know means only trained, authorized people may see your CORI. Access is limited to those who need it for the stated purpose. Your form acknowledges that your information will be handled with care and shared only with those allowed to see it.
• Secondary Dissemination is when a report is shared beyond the original stated purpose. Most policies prohibit sharing your CORI outside the requesting organization and the screening company. Your authorization does not approve broader sharing unless clearly stated and allowed.
• Dispute and Reinvestigation is your right to challenge inaccurate or incomplete information in a report. If you find an error, you can ask the screening company to recheck the data. Your form often explains how to make that request and how the organization will pause decisions while the review happens.
• Retention and Disposal refers to how long your form and any CORI report will be kept and how they will be destroyed. Organizations should store them securely and dispose of them safely when no longer needed. Your form signals that you understand these handling practices.

FAQs

Do you have to sign this form?

You do if you want the organization to consider you for the role that requires a CORI check. Without your authorization, the organization cannot request your CORI. If you choose not to sign, the organization may stop your application because it cannot complete the required screening.

Do you have to provide your Social Security number?

You typically provide only the last four digits. This helps match records and reduce errors. If you do not provide it, the screening may rely on name and date of birth alone, which can lead to delays or mismatches. Do not write your full number unless the form explicitly asks for it.

Do you get a copy of your CORI report?

You can usually request a copy. Look for a checkbox or language on the form allowing you to receive one. If the organization might take an adverse action, you should receive a copy of the report before a final decision, giving you time to review and respond.

Do you need to disclose sealed or expunged records?

You generally should not disclose records that you are not legally required to share. If records are sealed or expunged, they may not appear in the CORI report. Do not guess. Answer the form’s questions as written, and do not list records you are told not to disclose.

Do you need a new form each time you apply?

Often, yes. Authorizations are typically specific to the organization, the purpose, and a timeframe. If you apply for a new role, a new placement, or a different purpose (like moving from volunteer to paid employment), expect to sign a fresh authorization.

Do you have time to respond if something negative appears?

Yes. If the organization may take an adverse action because of your report, you should get a notice and a copy of the report. You will have time to dispute any errors. Use that window to request a reinvestigation and share any documents that support your correction.

Do you have to notarize the form or sign in person?

Usually no. Many organizations accept electronic signatures or signatures collected through a secure portal. If identity verification is needed, you may be asked to upload a photo of your ID or show it in person. Follow the instructions you receive.

Do you need to list former names and addresses?

Yes, list the names you have used and your recent addresses. Former names, nicknames, maiden names, and changes due to marriage or court orders help ensure an accurate match. Leaving them out can cause delays or a no-records-found result when records exist under a prior name.

Checklist: Before, During, and After the Criminal Offender Record Information – Acknowledgement Form

Before signing

• Gather your government-issued photo ID. Make sure the name matches what you will write.
• Confirm your full legal name, any former names, and name suffix (Jr., Sr., II, etc.).
• Confirm your date of birth and the last four digits of your Social Security number.
• Have your current address and recent prior addresses.
• Know the purpose of the check (employment, volunteer, subcontractor, licensing, housing).
• Confirm the requesting organization’s official name and contact information.
• Understand how you will submit the form (secure portal, email upload, or in person).
• Decide whether you want a copy of your report and how you want to receive it.
• Review the organization’s privacy and data handling notice if provided.
• Set aside uninterrupted time so you can complete the form in one sitting.

During signing

• Verify that the organization’s name and stated purpose match your situation.
• Check that your name appears exactly as on your ID, including hyphens and suffix.
• Enter all former names, including maiden names and common nicknames used on records.
• Confirm your date of birth is correct and legible.
• Provide only the last four digits of your Social Security number if requested.
• Review any attestations carefully. Do not certify anything you do not understand.
• Look for the checkbox to request a copy of your report. Select it if you want one.
• Confirm the timeframe of your authorization and whether it covers ongoing checks.
• Read the sections on your rights, dispute procedures, and adverse action notices.
• Sign and date in the required fields. Use the correct signature format if electronic.
• If uploading an ID, make sure the image is clear, not cropped, and shows all corners.

After signing

• Save a copy of the signed form for your records, if allowed.
• Note the date and method of submission. Screenshot any confirmation page or email.
• Confirm the organization received the form and that your submission is complete.
• Mark your calendar to follow up if you do not hear back within the expected timeframe.
• Watch for a notice that your report is ready or that an adverse action is being considered.
• Review your report promptly if you receive it. Highlight anything you believe is inaccurate.
• If needed, submit a dispute to the screening company and notify the organization.
• Keep your contact information current so you do not miss time-sensitive notices.
• If you withdraw your application, ask whether your authorization can be revoked and how your data will be disposed of.

Common Mistakes to Avoid

• Don’t forget to use your legal name and correct suffix. Using a nickname or dropping a suffix can cause mismatches or missed records. Consequence: delays, extra identity checks, or an incomplete search.
• Don’t leave out former names. Omitting a maiden name or prior legal name is a top reason for “no record” results when records exist. Consequence: the organization may need to rerun the check, slowing your application.
• Don’t transpose numbers in your date of birth or Social Security digits. Small typos create big delays and can trigger identity verification requests. Consequence: your start date or placement could be pushed back.
• Don’t skip the copy request if you want to see your report. Many forms include an opt-in. Consequence: you might wait to see your report until an adverse action notice, losing time to respond.
• Don’t submit unreadable IDs or incomplete pages. Cut-off images, heavy glare, or blurry scans can invalidate your submission. Consequence: you will be asked to resubmit, adding days to the process.

What to Do After Filling Out the Form

1. Submit the form exactly as instructed. Use the secure portal or method provided. If a portal times out, log back in and confirm the upload completed. If you are emailing, follow any encryption or password steps.
2. Confirm receipt. Ask the organization to confirm they have your signed authorization and any required ID. Keep any confirmation numbers.
3. Track timing. Background checks often have predictable timelines. If you do not hear anything by the expected date, follow up with a short, clear message. Ask whether additional information is needed.
4. Watch for notices. If the organization is considering an adverse action, you should receive a notice and a copy of the report. Read both carefully. Note the response deadline.
5. Review your report promptly. Check names, dates of birth, and case details. If something looks wrong, gather supporting documents such as court dockets, dispositions, or identity documents that show the error.
6. Dispute inaccuracies right away. Contact the screening company to start a reinvestigation. Be specific about what is wrong and include documentation. Tell the organization you are disputing and request that it pause its decision until the review is complete.
7. Ask questions if something is unclear. If you see terms you do not understand, ask the organization’s contact to explain. Use simple, direct questions: what was searched, what matched, and what happens next.
8. Update your contact details. If your phone or email changes, notify both the organization and the screening company (if you have a case number). This keeps you reachable during tight response windows.
9. Request appropriate disposal when the process ends. If your application is withdrawn or denied, you can ask how long your authorization and report will be kept and how they will be destroyed. Keep your own copy only as long as you need it, then store or shred it securely.
10. Plan for future checks. If you are moving to a different role or purpose, expect to sign a new authorization. Reuse your checklist so you can complete the next form quickly and accurately.