Get Scr-1 Lic State Central Registry Disclosure Form 2016.pdf - Dcfs Louisiana 2020-2025

The SCR-1 LIC State Central Registry Disclosure Form is an essential document required by the Louisiana Department of Children and Family Services. Completing this form accurately is crucial for individuals involved in specialized care or juvenile detention facilities. This guide provides a comprehensive overview of how to fill out the form online.

Follow the steps to complete the SCR-1 LIC form efficiently.

1. Click ‘Get Form’ button to obtain the form and open it in your chosen online editor.
2. Begin by entering the name of the licensed facility. This should be printed or typed clearly in the designated field.
3. Next, input the physical address of the licensed facility, ensuring all details are accurate.
4. Fill in the license number of the facility. This is typically provided by the Louisiana Department of Children and Family Services.
5. Provide your full name in the 'Name of Individual/Applicant' field, again ensuring clarity.
6. Enter your date of birth in the appropriate format.
7. Fill in your social security number accurately to avoid any discrepancies.
8. If applicable, include your maiden name, previous names, or any other names used in the space provided.
9. Select your race and sex by checking the appropriate boxes.
10. Provide your current street address, ensuring it includes city, state, and zip code.
11. Fill in your most recent previous address if applicable, including city, state, and zip code.
12. Enter your current home phone number and cell phone number in the specified format.
13. Indicate whether your name is or is not recorded as a perpetrator on the State Central Registry by checking the appropriate box.
14. Provide a statement regarding your history with abuse or neglect findings, completing the relevant fields.
15. Authenticate the form by signing and dating it in the designated areas.
16. If applicable, have a representative from the licensed facility sign and date the form.
17. Once all sections are completed, save changes, and choose to download, print, or share the form as needed.

Complete the SCR-1 LIC State Central Registry Disclosure Form online to ensure compliance and maintain transparency.