DCPS Employment Clearance - Add Application

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Application Completion Acknowledgemt

The DCPS Clearance Application cannot be completed on a mobile device or tablet, as not all information is saved and transferred with submission. Please complete this application on a computer or laptop. Via this acknowledgement, please confirm you are not submitting the clearance application via a mobile device. If you attempt to submit the application via a mobile device and your submission results in a technical error, you may be asked to resubmit your application via a laptop/desktop device.

Are you completing the clearance application via a mobile device? *

Review Carefully BEFORE Starting

The first step in the DCPS clearance process is to submit this Clearance Application.

1. Please review all of the information on this page carefully BEFORE clicking the �Submit a Clearance Application� icon to the right to begin.
2. You can also return to this page for reference after you submit your Clearance Application.
3. Please do not complete the Clearance Application on a mobile device or tablet as not all information is saved and transferred with submission. Please complete it on a computer or laptop.

The number of steps you will be required to take in the clearance process varies based on your relationship to DCPS. This overview describes ALL possible steps � your individual Clearance Application will populate based on the answers you provide. In your clearance application confirmation email, the required steps are outlined for your specific role with DCPS.

All individuals are required to complete some or all of the following suitability screenings based on the services/ work being done with DCPS:

1. Submit a DCPS Clearance Application
Failure to submit this application first will prevent the DCPS Clearance team from processing fingerprinting results, documenting other required steps, or issuing clearance compliance. The DCPS Clearance application must be completed in one sitting. Most of the information is standard demographic and employment (or volunteer) information however you are encouraged to scroll through the application and review the requested information before starting.

2. Complete a Criminal Background Check
DCPS has partnered with FieldPrint to offer remote fingerprinting services. After you submit your DCPS Clearance Application you will receive an email with next steps to complete the FBI Criminal Background Check.

3. Submit Tuberculosis (TB) Risk Assessment and, if applicable, TB Test Results
The Clearance application contains self-reported TB Risk Assessment Screening questions regarding your travel history, TB testing history, and possible TB virus exposure.

- Based on how you respond to these questions, the assessment will either satisfy the TB screening requirement, or you will be directed to complete and submit a TB test. Guidance on your next steps and whether you are required to provide a TB test will be provided in an automated email sent to you once this application has been submitted.

- For more information about the TB Testing Requirement, please see the bottom of this page. SOME categories of individuals seeking DCPS Clearance must also complete one or more of the following: Your individual Clearance Application will populate based on the answers you provide.

4. Sex Offender Register (SOR) Check
A SOR check will be automatically run by DCPS as part of the clearance process; therefore, no action steps are required from you.

5. Mandatory Drug and Alcohol Testing (MDAT)
Positions classified as �safety-sensitive� positions � those with a significant degree of contact with students � require drug and alcohol testing. More information about MDAT and how to schedule your MDAT appointment is in the Clearance Application.

To view or begin the DCPS Clearance Application, please click the �Submit a Clearance Application� icon to the right and to launch the application. Carefully follow all instructions in all sections.

Please complete the District of Columbia Public Schools (DCPS) Clearance Application provided below. Although you must enter personal information into our secure application, this is for identification purposes only and not used for any other reason. *=Required

Please describe your relationship to DCPS.
A DCPS Employee (prospective or current) is someone who has or will receive an offer of employment for a DCPS school or office.
A Contractor/Program provider is someone who is receiving pay for services provided to DCPS, either independently or through a partner organization, but is not an employee of DCPS.
A Volunteer, Unsupervised and Supervised is someone who is offering services to DCPS schools or offices with no compensation and may be with students alone at times and/or supervised during programming.
An Athletic Coach is someone who provides coaching services to DCPS, either paid or unpaid.
A Student Teacher or Intern is someone who is providing services through an educational or vocational program.
*

Please select the type of services you are providing to DCPS:

Please select the type of volunteer services you are providing to DCPS

Organization (Note: If you do not see your organization listed, please select the �other� option)

Type name of the organization

Please select the DCPS position type:

Employer Contact Person

Employer Email

Employer Phone Number

ext.

School/Department Name

School Placement Information: Please list the DCPS school or schools where you are confirmed as a volunteer. You may list up to five schools, with one school in each box below. The volunteer clearance letter will state that you are cleared for all DC public schools. However, we must be able to verify that you have a confirmed placement at the school(s) listed on your application.

School 1

School 2

School 3

School 4

School 5

If applicable, name of Community Based Organization/Program placing you in a DC public school

Are you a family member of a current DCPS student?

Point of Contact: Please enter information about either a DC public school or a partner organization so DCPS can confirm your placement

DCPS/ Program Point of Contact Name

DCPS/ Program Point of Contact Phone

ext.

DCPS/ Program Point of Contact Email

MDAT for Contractors/Coaches

Please indicate whether you are a New Contractor or Renewing your (contractor/coaching) Clearance. Please note that if you have had a break in service with your agency or organization since you began providing services to DCPS, a drug test is required, and you will have to select New Contractor/Coach. Also, if you have not been issued with a contractor/coaching clearance letter within the last two years, please select New Contractor/Coach.

Contractor/Coach Type

Have you had a break in service of 90 days or longer?

MDAT for Contractor/Coach

Student Teacher Details

Please complete this entire form in order to submit your application to student teach with DC Public Schools.

College/University

Please indicate your course director or university contact's name, phone number and email address.

Program/ Course Directors Name

Program/ Course Directors Phone Number

ext.

Program/ Course Directors Email Address

Coaching Application

Do you have a valid first aid certificate?

Volunteer Statement of Commitment

Statement of Commitment

As a volunteer working in the District of Columbia Public Schools, I agree to:

1. Sign in and out at the designated place during each visit.

DCPS tracks volunteer hours in each school. The efforts by individuals, volunteers and schools are recognized by DCPS as a quality service provided to students and staff.

2. Receive and wear a sticker provided from the front office to ensure school safety.

This will ensure that you are acknowledged as a contributing member of the school team during your volunteer time.

3. Attend any orientation or training session that may be necessary to help me in my job.

4. Honor the commitment to work as scheduled.

If you have a child in DCPS, please do not use your volunteer time to speak to your child's teacher or other staff members about your child. Schedule an appointment to address concerns related to your child.

5. Notify the DCPS representative assigned to work with me if I must be absent from a volunteer commitment.

6. Abide by all the school rules and DCPS policies and regulations that are applicable to me.

7. Maintain the confidentiality of any information I learn during volunteer work.

8.I agree that neither I, nor anyone acting on my behalf, shall sue DCPS, the District of Columbia or any employee or agent of the District of Columbia (the �District�) in regard to all claims, liabilities, suits, or expenses (hereafter collectively �claim� or �claims�), with the exception of any claims caused or alleged to be caused by the gross negligence, recklessness, or intentional misconduct of the District, for any injury, damage, or other loss to me in any way connected with my participation in this activity, or my use of District equipment or facilities (hereinafter �injuries�). I further hereby release the District from all claims for injuries with the exception of any claims caused or alleged to be caused by the gross negligence, recklessness, or intentional misconduct of the District.

When you discuss students' needs with the teacher, you may learn some personal information. Such information must remain confidential and must not be discussed, except with appropriate staff members as needed.

Inform appropriate staff members, teachers, school counselor, and school principal if I suspect and/or learn that a child is in danger or exposed to any type of abuse or neglect.

Electronic Signature

Volunteer Acknowledgment of Risks

Acknowledgment of Risks, Assumption of Risks, and Release/Waiver Agreement for DCPS Volunteer Activities PLEASE READ THIS ENTIRE DOCUMENT CAREFULLY BEFORE SIGNING.

I acknowledge and agree as follows:

Volunteer Acknowledgment of Risks

I have read and will abide by the Volunteer Statement of Commitment in this application form.
I must sign the District of Columbia Public Schools' (DCPS) Acknowledgement of Risks, Assumption of Risks, and Release/Waiver Agreement before participating in the DCPS volunteer activity listed above.
If I am the parent or legal guardian of a child under 18, I must sign a separate Acknowledgement of Risks, Assumption of Risks, and Release/ Waiver Agreement for my child before they can participate in the volunteer activity listed above.
I acknowledge that some of the activities include risks that may cause or lead to injuries to volunteers. I understand that DCPS staff, employees or other personnel cannot assure volunteers' safety or eliminate these risks. I am voluntarily participating with knowledge of the all risks inherent in my volunteer activity. Therefore, I assume and accept full responsibility for the risks of this activity (both known and unknown), and for any injury, damage, or other loss suffered by me, resulting from those risks.
I will perform only those tasks assigned, observe all safety rules, and use care in the performance of my volunteer assignments.
I will perform assigned tasks which are within my physical capability to the best of my ability, and that I will not undertake tasks that are beyond my ability or physical capability.
I am familiar with the safe operation and use of equipment and tools that I may utilize in connection with this volunteer activity, and I will not undertake to use any equipment or tools with which I am unfamiliar or do not know how to operate safely.
I agree to release and not to sue DCPS, the District of Columbia and any employee or agent of the District of Columbia (the 'District') in regard to all claims, liabilities, suits, or expenses (hereafter collectively 'claim' or 'claims'), including claims caused or alleged to be caused by the negligence of DCPS or District personnel, for any injury, damage, or other loss to me in any way connected with my participation in this activity, or my use of DCPS or District equipment or facilities. I understand that I agree to waive all claims I may have against DCPS or District personnel related to my participation in this activity, and agree that neither I, nor anyone acting on my behalf, will make a claim or file a lawsuit against DCPS, the District or District employees or agents for any injury, damage, or other loss to me in any way related to my participation in this activity.
I specifically acknowledge that I am engaging in this activity as a volunteer, at my own request and risk, and not as an employee of DCPS or their sponsors, and further acknowledge that I am not entitled to any payment, compensation, insurance coverage or any other benefit from DCPS or their sponsors, nor will I make such a claim.
I have carefully read and I understand all statements in this document, I am signing this document voluntarily, and I acknowledge that all terms in this document shall be effective and binding upon me, my minor children and other family members, and my heirs, executors, representatives and estate, as applicable.

Electronic Signature

MDAT for Prospective Employees

The District of Columbia Public Schools (DCPS) is committed to protecting the safety, health, and welfare of the young people in its charge. DCPS has established a Mandatory Drug and Alcohol Testing (MDAT) Program for employees, and contractors. DCPS drug testing process tests for the presence of opiates, amphetamines, phencyclidine (PCP), Cocaine, and marijuana for non-contractors. Contractors will not be subject to the screening of marijuana as part of their pre-service testing. Individuals who are participants in a certified Medical Marijuana Program must submit a copy of their medical marijuana card to the MDAT team at dcps.mdat@k12.dc.gov; the medical marijuana card must be submitted prior to taking the drug test. You may schedule your appointment by clicking the link here. In approximately 2-4 business days of submitting your information, you will receive an email from OTSWebApp@labcorp.com; with instructions to complete your drug screening test at a lab near your current location. Please be mindful in scheduling your appointment to allow yourself enough time to be able to remain at the lab to properly complete the test. Failure to complete drug testing, including failure to stay at the lab for any reason when requested to do so, will result in automatic cancellation of your hire request and you may be ineligible for hire for one year.

Applicant Information

Legal First Name *

Middle Name

Legal Last Name *

Preferred/goes by name (any)

Suffix

Maiden Name

SSN - Last 4 *

Valid Last 4 SSN

Full Social Security No. (Required for Federal Regional Fingerprinting)

Current Street Address *

Year you moved in *

Apt

City *

State *

Zip Code *

Phone *

Email Address *

Secondary/Organization Email

Demographic Information

The Federal Bureau of Investigation (FBI) requires the following information to complete your criminal background check. This information will not be used for purposes other than your background check.

Date of Birth *

Valid DOB

Gender *

Race *

Are You of Hispanic, Latino or Spanish Origin? *

Weight (lbs) *

Height (Feet) *

Height (Inches) *

Eye Color *

Hair Color *

Country of Citizenship *

For the questions below, please indicate the city, state and country that you were born in, not your current address.

Birth Country *

Birth State *

Birth City *

Sex Offender Register (SOR) Check

All individuals seeking DCPS Clearance must complete a Child Sex Offender Registry (SOR) check. The SOR check is currently processed through DCHR. Information needed for the SOR check is automatically sent on your behalf and no further action is needed by the applicant.

Have a Social Security Number?

Full SSN for SOR

Valid SSN

Authorization, Affirmation & Disclosure

Criminal Background Information: You must answer each question in this section before we can process your application

When answering the following questions, do not include: (1) any convictions that occurred prior to age 18, if the matter was handled in juvenile court; (2) any conviction that has been was expunged under federal, state, or local law. You must include all other convictions for any criminal offenses, even if you did not receive a jail/prison sentence for the conviction. Please include all traffic offenses. Please list all criminal offenses in all jurisdictions from age 18 to present. Please list offenses even if you are unsure of the final outcome of the offense.

We will consider the date, facts, and circumstances of each event you list.

Have you ever (except as stated above) been convicted of any criminal offense? *

Explanation of Convictions: Please give the following details for each conviction: (date of offense, charge(s) you were convicted of, place of violation, sentence/incarceration length, any additional information necessary). If you have received a pardon for a criminal conviction, please list the conviction unless it was expunged as a result of the pardon.

Probation/Parole/Supervised Release: Are you currently on probation, supervised/unsupervised release from prison, or parole?

If " Yes " please state: (1) start/end dates; (2) conditions of probation/release/parole.

Pardons: If you received a pardon(s) for one or more of your criminal convictions, review the law concerning pardons in the state where you received your pardon. Some states do not expunge at a conviction even if you have received a pardon for it. If you have been pardoned for an offense but it has not been expunged, list the offense.

Please give the following details for each pardoned but non expunged conviction: (date of offense, charge(s) you were convicted of, place of violation, sentence/incarceration length, any additional information necessary)

Pending Criminal Charges: Do you currently have any pending criminal charge(s)/case(s) against you (no time limitation)? *

Please list the pending charges below:

United States Armed Service

Have you ever been discharged from the Armed Services under other than Honorable conditions? *

Please provide the following details: date of offense, charge(s) you were convicted of, place of violation, sentence/incarceration length, any additional information necessary.

Criminal Background Check Affirmation

Please read the listed offenses and then indicate the appropriate declarations in the section below.

1. Murder, attempted murder, manslaughter, or arson;
2. Assault, assault with a dangerous weapon, mayhem, malicious disfigurement, or threats to do bodily harm;
3. Burglary;
4. Robbery;
5. Kidnapping;
6. Illegal use or possession of a firearm;
7. Sexual offenses, including indecent exposure; promoting, procuring, compelling, soliciting, or engaging in prostitution; corrupting minors (sexual relations with children); molesting; voyeurism; committing sex acts in public; incest; rape; sexual assault; sexual battery; or sexual abuse; but excluding sodomy between consenting adults;
8. Child abuse or cruelty to children
9. Intrafamily offenses
10. Unlawful distribution of or possession with intent to distribute a controlled substance.
11. Fraud
12. Identity theft
13. Embezzlement; or
14. Computer/cybercrime

DIRECTIONS: You must review each DECLARATION AND ANSWER EACH STATEMENT AS TRUE OR FALSE

I have not been convicted of any of the above listed offenses or their equivalent, either in the District of Columbia, or in any other state or territory. *

I have not pleaded nolo contendere to any of the above listed offenses or their equivalent, either in the District of Columbia, or in any state or territory. *

I am not currently on probation, supervised/unsupervised release from prison, or parole for any of the above listed offenses or their equivalent, either in the District of Columbia, or in any state or territory. *

I have never been found not guilty by reason of insanity for any of the above listed offenses or their equivalent, either in the District of Columbia, or in any state or territory. *

I am not on probation before judgment for any of the above listed offenses or their equivalent, either in the District of Columbia, or in any state or territory.

I do not have placement of a case upon a stet docket for any of the above listed offenses or their equivalent, either in the District of Columbia, or in any state or territory.

Child Abuse, Sexual Misconduct, License

1. I have never been the subject of any child abuse or sexual misconduct investigation by any employer, state licensing agency, law enforcement agency, or the Child and Family Services Agency or another state s equivalent, unless the investigation resulted in a finding that the allegations were false, or the alleged incident of child abuse or sexual misconduct was not substantiated. *

True
False
None of the above

2. I have never been disciplined, discharged, nonrenewed, asked to resign from employment, resigned from or otherwise separated from any employment while allegations of child abuse or sexual misconduct were pending or under investigation, or due to an adjudication or finding of child abuse or sexual misconduct. *

True
False
None of the above

3. I have never had a license, professional license, or certificate suspended, surrendered, or revoked while allegations of child abuse or sexual misconduct were pending or under investigation, or due to an adjudication or finding of child abuse or sexual misconduct. *

True
False
None of the above

Tuberculosis Risk Assessment

All candidates, employees, volunteers, program partners, contractors, coaches, student teachers, and interns must complete a TB Risk Screening Assessment, below.

Once you have submitted your responses and completed this Clearance Application, you will receive an email that indicates whether you have satisfied the TB requirement or are required to obtain a TB test to move forward in the clearance process. If you are directed to obtain a TB test, further details regarding this process and requirements will be included in the email notification.

Have you obtained a DCPS Clearance in the past? *

Yes
No
None of the above

Tuberculosis Related History

Since your last DCPS Clearance:

Have you had a positive TB skin test (Mantoux TST) or blood test (QuantiFERON/ TSpot)?

Yes
No
None of the above

Have you ever had a positive TB skin test (Mantoux TST) or blood test (QuantiFERON / TSpot)? *

Yes
No
None of the above

When? *

Have you ever been diagnosed with tuberculosis? *

Yes
No
None of the above

Have you been diagnosed with tuberculosis?

Yes
No
None of the above

Year Treated: *

Treatment Duration: *

Location: *

TB Medication Taken *

Have you ever received the bacille Calmette-Guerin (BCG) vaccine for tuberculosis? (Note: This vaccine is not routinely provided in the U.S.) *

Yes
No
None of the above

Have you received the bacilli Calmette-Guerin (BCG) vaccine for tuberculosis? (Note: This vaccine is not routinely provided in the U.S.)

Yes
No
None of the above

TB Risk Assessment

Since your last DCPS Clearance:

Have you had temporary or permanent residence (for 1 month or longer) in a country with a high TB rate? For a list of High Burden TB Countries, please click the following link *

Yes
No
None of the above

Have you had temporary or permanent residence (for 1 month or longer) in a country with a high TB rate?For a list of High Burden TB Countries, please click the following link

Yes
No
None of the above

list of countries

Do you have any current or planned immunosuppression, including human immunodeficiency virus infection, receipt of an organ transplant, treatment with a TNF-alpha antagonist (e.g., infliximab, etanercept, or other), chronic steroids (equivalent of prednisone 15 mg/day for 1 month), or other immunosuppressive medication *

Yes
No
None of the above

Have you had close contact with someone who has had infectious TB disease since the last TB test *

Yes
No
None of the above

Have you had close contact with someone who has had infectious TB disease since the last TB test?

Yes
No
None of the above

Tuberculosis Symptom Screen

Do you currently have any of the following?

Cough for longer than two weeks? *

Yes
No
None of the above

Coughing up blood? *

Yes
No
None of the above

Soaking night sweats? *

Yes
No
None of the above

Weight loss of more than 10 lbs over the last year without dieting? *

Yes
No
None of the above

Persistent fevers (> 100.4 F) for more than two weeks *

Yes
No
None of the above

Acknowledgements and Authorizations

Affirmation of Responses

I hereby affirm my responsive declaration to each statement on this Clearance Application.

Confirm *

Criminal Background Check Fingerprinting Affirmation, Authorization, and Disclosure Form

This form requests information from you about your history with law enforcement and requests your permission for DCPS to conduct a criminal background check on you.

I hereby acknowledge that I have received the DCPS Individual Notification of Criminal Background Check and Traffic Record Check Requirements.

Confirm *

Authorization to Release Information to DCPS

This is to certify that I am applying to become an employee, contractor or volunteer for the District of Columbia Public Schools (DCPS) and that I do hereby authorize the release of any information to DCPS that they may request, from whomever they deem necessary to make such a request, from any of my police records, arrest records, and court records located at any jurisdiction in which I have lived and/or worked. I also release all persons from any liability that could result from furnishing said information to DCPS. The original document is to be retained on file with DCPS. Any information obtained will be provided to law enforcement agencies, including the Federal Bureau of Investigation (FBI).

I understand that the FBI may allow other Federal law enforcement agencies to have access to my information.

Confirm *

Acknowledgement of Right to Obtain copy of Criminal Background Report

I have been informed that the District of Columbia Public Schools is authorized to conduct a criminal background check on me and may choose to deny employment or a contractor/volunteer position to me, or terminate my employment or contractor/volunteer position, based on the outcome of the criminal background check.

I have been informed of my right to obtain a copy of the criminal background check report and to challenge the accuracy and completeness of that report.

Confirm *

Acknowledgement of Receipt of MDAT Policy

In accordance with the Child and Youth, Safety and Health Omnibus Amendment Act of 2004, all DCPS safety-sensitive employees and contractors are subject to drug and alcohol testing for Pre-Employment/Service, reasonable suspicion of drug or alcohol use while on duty, before being permitted to return to duty after seeking drug or alcohol treatment, periodically as a follow-up to drug or alcohol treatment, and after an accident while on duty. All employees and contractors are expected to comply with the requirements of this Policy, including those who refuse to acknowledge receipt of the Policy. Employees and contractors who test positive for drugs or alcohol, without a legitimate medical reason, or who refuse to submit to testing when so instructed will be ineligible for hire into a safety-sensitive position with DCPS for one (1) year.

By providing my electronic signature below, I acknowledge that I have received and read the DCPS Employee Mandatory Drug and Alcohol Testing Policy.

Confirm *

Certification and Authorization of Criminal Background Check

I understand that a false statement on any part of my application may be grounds for not hiring me, or for firing me after I begin working. (D.C. Code � 1-661.51 et.seq. (2001) and D.C. Mun. Regs. �� 405.8 and 407.1). I understand that the making of a false statement on this form or any materials submitted as part of my application is punishable by criminal penalties pursuant to D.C. Code � 22-2405 et seq. (2001). I understand that any information I give may be investigated as allowed by law or Mayoral order. I consent to the release of information regarding my suitability for District of Columbia Government employment by employers, schools, law enforcement agencies, the Federal Bureau of Investigation (FBI) and other individuals and organizations to investigators, personnel staffing specialists, and any other authorized employees of the District of Columbia government. I understand that the FBI may allow other Federal law enforcement agencies to have access to my information

I hereby authorize the District of Columbia Public Schools to conduct a criminal background check.

Confirm *

Consent and Authorization of Sex Offender Register (SOR) Check

I hereby confirm that I have provided complete and accurate information. I understand that if I knowingly provide incomplete or false information. My typed name below indicates my consent to proceed with the SOR check.

Confirm *

Acknowledgment of Requirement to Self-Report Arrest or Criminal Charge

I understand that I am required to notify my supervisor and the Office of Employee Services if I am arrested or charged with any criminal offense (D.C. Mun. Regs �6B 416.4). I further understand that this notification must be made within seven (7) days of arrest or criminal charge, and that failure to make the required notification will result in applicable disciplinary action up to and including termination.

Confirm *

Dual Employment Acknowledgement

I acknowledge that I have read and understand the District government�s policy on holding multiple jobs, as outlined in Issuance I-2021-6. I am aware that employees may hold multiple jobs within or outside the District government, provided these positions do not create an actual or perceived conflict of interest, interfere with official duties, or expose the District to overtime liabilities under the Fair Labor Standards Act.

For additional information, please refer to the policy details available at the Issuance linked above.

Confirm

Electronic Signature *

Date Signed *

Please click "Save and Close" on the top right corner to submit your application and receive information about next steps.

Hidden Section

Volunteer School 1 Code

Regional Fingerprinting Candidate?

Application Type

Admin details

CPR Required Application

TB Requirement

N/A

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