Get Department Of Health Services State Of Wisconsin F-82064 - Wctc

This guide provides clear and supportive instructions for completing the Department of Health Services State of Wisconsin F-82064 form online. It aims to help users navigate each section effectively, ensuring that all required information is submitted appropriately.

Follow the steps to complete the F-82064 form online.

1. Click the ‘Get Form’ button to access the form and open it for editing.
2. Begin by selecting the appropriate box that applies to your situation: whether you are an employee, contractor, applicant for a license, or another status. Ensure that your choice reflects your current status accurately.
3. Provide your first and middle names in the designated fields, followed by your last name. Should you have any other names, including a maiden name, list them in the provided space.
4. Enter your date of birth and race in the respective sections, selecting one of the options provided.
5. Fill out your home address, including city, state, and zip code. Include your social security number if you choose to provide it, noting that it is voluntary but helps in avoiding incorrect matches.
6. If you are employed or contracted, fill in the business name and address of your employer or care provider.
7. Proceed to Section A, which addresses acts, crimes, and offenses that could restrict your ability to work. Respond to each question honestly and provide details as required, including listing any relevant information about past charges or convictions.
8. In Section B, answer all questions related to any government or regulatory agency actions against you regarding your licensing, residency, military discharge, and background checks. Provide explanations as necessary.
9. Sign and date the form, certifying that the information provided is accurate. This step is crucial as it confirms your understanding of the implications of providing false information.
10. After completing the form, save your changes. You can then proceed to download, print, or share the completed form as needed.

Take the next step towards completing your documentation online by filling out the F-82064 form now.