VENDOR REGISTRATION WITH BE A MENTOR, INC. (Employee/Volunteer Background Clearances)

School District or Company You Are Contracting With             (ORGANIZATION)
Example: XYZ Unified School District
Example: XYZ Company

Vendor Name                                                                               (VENDOR)

Contact Name

Contact Phone No

Contact Email Address

Vendor mailing address

I hereby authorize Be A Mentor, Inc. to conduct background clearances on individuals associated with VENDOR and to receive clearance and rejection email letters sent by Be A Mentor, and I agree to receive notices regarding further criminal offenses for which individuals are arrested.

I certify that VENDOR is registered with Be A Mentor to receive background clearances for their representatives. Unless specifically waived by (ORGANIZATION), VENDOR is required to screen representatives who will be working at ORGANIZATION sites for more than six hours for Tuberculosis. Additionally, unless specifically waived by ORGANIZATION, for all representatives providing services to ORGANIZATION, VENDOR shall ensure completion of criminal background investigation, and shall request and regularly review subsequent arrest records. VENDOR agrees that ORGANIZATION will be notified of individual background clearance discrepancies and subsequent arrests. When each representative is cleared, an individual clearance letter will be sent to the individual with a copy to VENDOR’s contact. ORGANIZATION may inspect individual clearance letters as per the ORGANIZATION Professional Services Agreement. Subsequent Arrest notifications will be sent to VENDOR’s contact with a copy to ORGANIZATION's designated person.

All school site participants shall act in accordance with ORGANIZATION's policies, regulations, school rules and directives of the supervising employee or administrator.

By checking these boxes, I agree to and understand that ORGANIZATION clearance requirements are:

Tuberculosis Screening. Unless specifically waived by ORGANIZATION, VENDOR is required to screen employees who will be working at ORGANIZATION sites for more than six hours. VENDOR agents who work with students must submit to a tuberculosis risk assessment as required by Education Code section 49406 within the prior 60 days. If tuberculosis risk factors are identified, VENDOR agents must submit to an intradermal or other approved tuberculosis examination to determine that they are free of infectious tuberculosis. If the results of the examination are positive, VENDOR shall obtain an x-ray of the lungs. VENDOR, at its discretion, may choose to submit the agent to the examination instead of the risk assessment.

Criminal Background Investigation. Unless specifically waived by ORGANIZATION, for all VENDOR employees, volunteers, and agents providing the Services. VENDOR shall ensure completion of criminal background investigation, and shall request and regularly review subsequent arrest records. VENDOR confirms that no employee, volunteer, or agent providing the Services has been convicted of a felony, as that term is defined in Education Code section 45122.1. VENDOR shall provide the results of the investigations and subsequent arrest notifications to ORGANIZATION.

VENDOR will pay a one-time registration and setup fee of Twenty-five dollars ($25.00).

Please pay the one-time VENDOR registration payment set-up fee here: https://connect.clickandpledge.com/w/Form/742d57e2-fd77-4f90-ad72-d2440af4a0c5


Each individual associated with VENDOR who is requesting a background clearance will register online. Be A Mentor will provide VENDOR with the registration link to be used by each individual associated with VENDOR. Upon completion of the registration form each individual will be charged a Twenty-five dollar ($25.00) processing fee and will make a payment by debit or credit card unless VENDOR prepays the fee for individuals.

I am duly authorized to sign on behalf of VENDOR to all of the above.

Name

Title

BY CLICKING "SUBMIT" you agree to the terms of this Agreement.