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ASSURSANCE OF LEGAL COMPLIANCE
<br />HEALTH AND SAFETY, EMPLOYMENT OF MINOR, FAIR LABOR PRACTICES, AND ANTI-DISCRIMINATION
<br />Required Background Checks
<br />Pursuant to RCW 28A.400.303, I confirm that any employee who will have unsupervised access to students of
<br />Everett Public Schools under this agreement shall be required to have successful completion of a background
<br />check through the Washington State Patrol Criminal Identification System, under RCW 4.43.830‐834, RCW 10.97.30
<br />& .50, and through the Federal Bureau of Investigation prior to accepting interns from the District and prior to
<br />unsupervised access to such students. I confirm that I shall not allow any contact between Everett Public School
<br />students and any employee when an employee has pled guilty to or been convicted of any felony crime involving
<br />the physical neglect of a child under Chapter 9A.42 RCW, the physical injury or death of a child under Chapter 9A.32
<br />or 9A.36 RCW (except motor vehicle violations under Chapter 46.61 RCW), sexual exploitation of a child under
<br />Chapter 9A.44 RCW where a minor is the victim, promoting prostitution of a minor under Chapter 9A.88 RCW, the
<br />sale or purchase of a minor child under 9A.64.030 RCW, or violation of similar laws of another jurisdiction. Any failure
<br />to comply with this section shall be grounds for the District to immediately terminate the internship. I confirm that
<br />the employer, at its own cost, will perform criminal background checks of all individuals providing services under
<br />this internship agreement, and as required by applicable and current Washington State and federal law.
<br />Background checks are to be processed through Washington State Patrol criminal investigation system and
<br />through the Federal Bureau of Investigation under RCW 28A.400.303.
<br />Transportation
<br />Depending on the internship requirements, student travel with their internship host may occur
<br />Family Educational Rights & Privacy Act
<br />I confirm that the employer is subject to the Family Educational Rights and Privacy Act (FERPA) (20 U.S.C. § 1232g; 34
<br />CPR Part 99) that protects the privacy of student education records. The law applies to all schools that receive funds
<br />under an applicable program of the U.S. Department of Education and District and Agency agree to abide by the
<br />stipulations and requirements of the FERPA rulings, as it exists at the time this form.
<br />Change of Worksite Supervisor
<br />The Worksite Supervisor may not be substituted without the prior approval of the district.
<br />Nondiscrimination
<br />Everett Public Schools does not discriminate in any programs or activities on the basis of sex, race, creed, religion,
<br />color, national origin, age, veteran or military status, sexual orientation, gender expression or identity, disability, or
<br />the use of a trained dog guide or service animal and provides equal access to the Boy Scouts and other designated
<br />youth groups.
<br />The following employees have been designated to handle questions and complaints of alleged discrimination: Title
<br />IX/Civil Rights Compliance Officer and ADA Coordinator:
<br />Chad Golden, 425-385-4100, CGolden@everettsd.org;
<br />Section 504 Coordinator:
<br />Dave Peters, 425-385-4063, DPeters@everettsd.org, PO Box 2098, Everett WA 98213
<br />I confirm that this worksite is in compliance with all provisions of local, state, and federal law which are applicable to
<br />this business including the following: occupational safety and health (WISHA and OSHA); employment of minors,
<br />fair labor practices, and payment of wages; and anti‐discrimination, anti‐harassment, and anti‐retaliation on the
<br />basis of any protected characteristic, including race, creed, color, national origin, religion, sex, sexual orientation,
<br />marital status, age, honorably discharged veteran or military status, any sensory, mental, or physical disability, or the
<br />use of a trained dog guide or service animal by a person with a disability, or any other characteristic protected by
<br />law. I understand and agree that harassment of any employee/student with regard to any of the protected
<br />characteristics listed above, and/or discrimination against any employee/student with regard to recruitment, hiring,
<br />placement, assignment of tasks, hours of employment, levels of responsibility, or pay, are strictly prohibited. I further
<br />understand and agree that any student performing work at this worksite shall receive a student orientation, which
<br />shall include training on safety procedures, accident prevention, and this employer’s anti‐discrimination, anti‐
<br />harassment, and anti‐retaliation rules and reporting procedures.
<br />Worksite Employer
<br />Signature: ______________________________________________________ Date: ________________________________06/16/2025
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