Get Department Of Health Services State Of Wisconsin F-82064a (02/2013) Chapters 48 - Www4 Uwm

Filling out the Background Information Disclosure form (F-82064A) is essential for compliance with Wisconsin's caregiver background check law. This comprehensive guide provides step-by-step instructions to assist you in accurately completing the form online.

Follow the steps to successfully complete the form.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Begin by reviewing the instructions provided on the first page of the form to understand its purpose and requirements. Ensure you are familiar with the types of information you will need to provide.
3. Fill out your personal information in the designated fields, including your first and last name, any other names you’ve been known by, birthdate, and home address.
4. Provide your social security number if you choose, and select your gender from the options provided. Note that this information helps to prevent incorrect matches in background checks.
5. In the section labeled 'Acts, Crimes, and Offenses,' answer each question truthfully regarding pending criminal charges and past convictions. If applicable, provide detailed descriptions of any incidents as requested.
6. Continue to Section B to disclose any limitations, denials, or restrictions on your caregiving credentials or licenses. Be specific in your explanations regarding any government actions taken against you.
7. Review all your entries to ensure accuracy and completeness. It is crucial to provide truthful information to avoid legal penalties.
8. Once you have filled in all the sections, you can save your changes, download the completed form for your records, and print it as needed. Choose to share the form with the relevant employer or agency as directed.

Complete the necessary documents online to ensure compliance and expedite your application process.