Get Criminal History Disclosure Form

Completing the Criminal History Disclosure Form is a crucial step for individuals seeking employment or licensing in child care services. This guide will provide user-friendly instructions, ensuring that all required information is accurately filled out online.

Follow the steps to successfully complete your Criminal History Disclosure Form.

1. Click ‘Get Form’ button to access the Criminal History Disclosure Form and open it in the editing interface.
2. Begin by entering your full legal name in the designated field. Ensure this matches official documents to avoid discrepancies.
3. Provide any birth name, maiden name, aliases, nicknames, or other married names in the appropriate section, if applicable. If there are no additional names, check the box indicating this.
4. Enter your date of birth in the format requested. Make sure it is accurate as it is essential for identification.
5. Fill in your social security number in the designated field. This information is important for the background check and is requested voluntarily.
6. Input your telephone number accurately for further communication needs regarding your application.
7. List all addresses where you have lived for the past five years, starting with your current address. Include the date ranges for each address.
8. If you need more space for additional addresses, continue on the second page of the form, ensuring all previous addresses are fully disclosed.
9. Review and acknowledge consent for background checks by signing and dating the form at the bottom. This allows the Department of Human Services to perform the necessary searches.
10. After completing the form, save your changes, and you may choose to download, print, or securely share the form as needed.

Complete your Criminal History Disclosure Form online today to ensure prompt processing of your application.