Step 6 of 8

CORI Request/Authorization Form

Employment Forms 06 - CORI Request/Authorization Form

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  • Authorization

    New England Home Health Services is registered under the provisions of M.G.L. c.6, § 172 to receive CORI for the purpose of screening current and otherwise qualified prospective employees, subcontractors, volunteers, license applicants, or current licensees. As a prospective or current employee, subcontractor, volunteer, license applicant or current licensee, I understand that a CORI check will be submitted for my personal information to the DCJIS. This authorization is valid for one year from the date of my signature. I may withdraw this authorization at any time by providing New England Home Health Services with written notice of my intent to withdraw consent to a CORI check. I also understand, that New England Home Health Services may conduct subsequent CORI checks within one year of date this Form was signed by me. By signing below, I provide my consent to CORI check and affirm that the information provided on Page of this Acknowledgement Form is true and accurate.
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