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  • Background Information Disclosure Appendix & Instructions, Hfs-69 & Hfs69a. Background

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DEPARTMENT OF HEALTH AND FAMILY SERVICES HFS-69A (Rev. 6/04) STATE OF WISCONSIN BACKGROUND INFORMATION DISCLOSURE APPENDIX INSTRUCTIONS License Holders and Nonclient Residents in Bureau of Quality.

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Use form DJ-LE-250 to request a criminal background check on a single individual. Use form DJ-LE-250A to request background checks on multiple persons. Wisconsin Statutes 19.35(1) and 165.82 provide that any person or entity may request a criminal background check. The subject of the inquiry may be any person.

• The Background Information Disclosure (form F-82064) gathers information as required by the Wisconsin Caregiver Background Check Law to help employers and governmental regulatory agencies make employment, contract, residency, and regulatory decisions. •

The Caregiver Law requires health care facilities to report incidents of caregiver misconduct and some injuries of unknown source to the Department of Health Services, Division of Quality Assurance. CAREGIVER MISCONDUCT means abuse of a client, neglect of a client, or misappropriation of a client's property.

A caregiver background check is a type of employment background check conducted by licensed community care providers on prospective employees, contractors, and volunteers who will perform direct care duties with vulnerable clients.

• The Background Information Disclosure (form F-82064) gathers information as required by the Wisconsin Caregiver Background Check Law to help employers and governmental regulatory agencies make employment, contract, residency, and regulatory decisions.

Access to criminal history information can be obtained on the Wisconsin Online Record Check System at http://recordcheck.doj.wi.gov. Adult criminal history information is public record in the State of Wisconsin. Anyone may obtain this information provided they pay the fee established by the Wisconsin Legislature.

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© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232
Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
DMCA Policy
About Us
Blog
Affiliates
Contact Us
Privacy Notice
Delete My Account
Site Map
All Forms
Search all Forms
Industries
Forms in Spanish
Localized Forms
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate workflows
DocHub
Instapage
Social Media
Call us now toll free:
1-877-389-0141
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232