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DOH CHRC 104 (9/06) 40214 EXPEDITED REVIEW REQUEST FORM NYS Department of Health FOR CRIMINAL HISTORY RECORD CHECK DOH use only. Leave Blank This form is to be submitted to the DOH CHRC Unit to secure.

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How to fill out the Chrc 104 online

This guide provides a comprehensive overview of how to fill out the Chrc 104 form online. Whether you are seeking employment or need to complete criminal history record checks, this step-by-step instruction will support you in submitting the form accurately and efficiently.

Follow the steps to complete the Chrc 104 form online.

  1. Press the ‘Get Form’ button to access the Chrc 104 online form in your preferred editor.
  2. Begin by filling in Section 1 with the subject individual's information. Include their Social Security Number, date of birth, last name, first name, middle initial, and any aliases or maiden names.
  3. Complete the personal details by entering the subject's sex, country of birth, race, height, weight, hair color, eye color, and phone numbers (home and cell).
  4. In Section 2, select the type of picture identification presented by the subject individual from the options provided. Fill in the issuing state, ID number, and expiration date of the ID.
  5. Next, proceed to Section 3 to provide the agency's identification details. Enter the name of the agency, authorized person's name, address, telephone number, and email.
  6. The authorized person must sign and date the form in Section 3, confirming that they have verified the subject individual's identification and that there is informed consent on file.
  7. Once all sections are completed, review the form for accuracy. Save any changes made, and then you can choose to download, print, or share the form as needed.

Complete the Chrc 104 form online to proceed with your application process.

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© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232
Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Your Privacy Choices
Terms of Service
Privacy Notice
Legal Hub
Content Takedown Policy
Bug Bounty Program
About Us
Help Portal
Legal Resources
Blog
Affiliates
Contact Us
Delete My Account
Site Map
Industries
Forms in Spanish
Localized Forms
State-specific Forms
Forms Kit
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
altaFlow
DocHub
Instapage
Social Media
Call us now toll free:
+1 833 426 79 33
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232