Get Background Disclosure Form

Completing the Background Disclosure Form is an essential step for individuals seeking employment or certification in care-related fields. This guide offers clear, step-by-step instructions on how to accurately fill out the form online, ensuring you provide the necessary information as required by Wisconsin law.

Follow the steps to effectively complete the form.

1. Press the ‘Get Form’ button to download the Background Disclosure Form and open it in your preferred document editor.
2. Begin by filling out your personal information. Provide your first and middle name, last name, any other names you have been known by, your birthdate, address, gender, race, and social security number. Ensure that this information is accurate to avoid future complications.
3. Indicate the category that applies to you by checking the appropriate box (employee/contractor, applicant for a license, household member, or other). This helps clarify your role in relation to the caregiving entity.
4. Complete Section A, detailing any criminal charges, convictions, or delinquency adjudications. If you answer 'Yes' to any questions, provide additional required details, including dates, locations, and relevant documentation.
5. Proceed to Section B and provide information regarding any limitations or revocations of licenses or certifications, discharge from the military, residing outside Wisconsin, background checks conducted, or rehabilitation reviews requested.
6. Review all provided information for accuracy and completeness. Ensure that each section is fully filled out and check your answers thoroughly.
7. Sign and date the form to affirm that the information is truthful and accurate. A signature is required to validate the submission.
8. Once completed, save your changes, download a copy of the form for your records, and print the form if necessary. Submit the form as instructed by the respective employer or regulatory agency.

Complete your Background Disclosure Form online today to streamline your application process.