Get Request For Staff Exclusion List Check Form
How it works
-
Open form follow the instructions
-
Easily sign the form with your finger
-
Send filled & signed form or save
How to fill out the Request For Staff Exclusion List Check Form online
Filling out the Request For Staff Exclusion List Check Form is a crucial step in ensuring the safety of service recipients. This guide will provide you with clear, step-by-step instructions to help you complete the form online effectively.
Follow the steps to accurately complete the form online.
- Click ‘Get Form’ button to access the Request For Staff Exclusion List Check Form and open it for editing.
- Enter the applicant's information in Part 1. Provide the last name, first name, date of birth, and social security number. Additionally, indicate the applicant type and provide their address along with the facility or provider name.
- Designate the state oversight agency by circling the appropriate option: OMH, OPWDD, OCFS, DOH, or OASAS.
- In Part 2, provide the authorized person's information. Clearly print the name, signature, and email address of the authorized person.
- Include the facility or provider name and address for the authorized person.
- Insert the authorized person's phone number and, if applicable, the alien registration number.
- Review all provided information for accuracy. Ensure that all required fields are completed.
- Once everything is filled out and reviewed, save your changes. You may download, print, or share the completed form as needed.
Complete the Request For Staff Exclusion List Check Form online today to ensure a safe environment for all service recipients.
Registrar's Office, 506-453-4864 Monday to Friday: 8:15 a.m. to 4:30 p.m. Phone and counter inquiries: 9 a.m. to 4:30 p.m.
Fill Request For Staff Exclusion List Check Form
The SEL must be checked as part of the comprehensive background check process for the individuals identified below and on the OCFS-6000 form. Instructions: This form is used to check the Justice Center's Staff Exclusion List (SEL). 1. Please complete all Parts of this form. 2. Request for Staff Exclusion List Check. This web form enables providers to submit a request online to check a job applicant's name against the justice center staff exclusion list. Click 'Get Form' to open the request staff exclusion list in the editor.
Industry-leading security and compliance
-
In businnes since 199725+ years providing professional legal documents.
-
Accredited businessGuarantees that a business meets BBB accreditation standards in the US and Canada.
-
Secured by BraintreeValidated Level 1 PCI DSS compliant payment gateway that accepts most major credit and debit card brands from across the globe.