Get Nc Dss-5268 2011

The NC DSS-5268 form is essential for requesting information from the Responsible Individuals List, which is necessary for ensuring the safety of children in care. This guide will provide you with clear, step-by-step instructions to assist you in completing this form online.

Follow the steps to successfully complete the form online.

1. Locate and click the ‘Get Form’ button to access the NC DSS-5268 and open it in your chosen form editor.
2. Begin by entering the full name of the Employee (E), Applicant (A), or Volunteer (V), including their middle initial.
3. Input the date of birth of the individual in the format MM/DD/YYYY.
4. Provide the last four digits of the individual’s Social Security Number.
5. Select the appropriate gender option for the individual by marking 'Male', 'Female', or specifying another option.
6. List any other names the individual has used, such as a maiden name or nickname.
7. Fill in the name of the agency requesting the information.
8. Provide the complete mailing address of the agency, including the city, state, and zip code.
9. Enter the phone number and fax number of the agency where the request will be sent.
10. Check the box next to the type of agency that corresponds to the request.
11. Sign and date the form to acknowledge the understanding of the disclosure of the Responsible Individuals List.
12. Once all fields are completed accurately, save the changes, and proceed to download, print, or share the form as needed.

Complete your NC DSS-5268 form online to ensure a smooth submission process.