Get Background Clearance Form - Hssu

Completing the Background Clearance Form - Hssu online is a crucial step for those seeking registration in the Family Care Safety Registry. This guide provides clear instructions to help users navigate each section of the form efficiently.

Follow the steps to successfully complete the Background Clearance Form - Hssu online.

1. Click the ‘Get Form’ button to obtain the Background Clearance Form - Hssu and open it in your preferred online editor.
2. In Section A, identify your worker type by checking one box that applies: child care worker, personal care worker, voluntary registrant, elder care worker, recipient of state or federal funds, or foster parent.
3. Move to Section B to provide identifying data for background screening. Enter your last name, first name, middle name, maiden name, any prior names used, and your Social Security number (attach a copy of your Social Security card). Then, fill in your date of birth, gender, telephone number (optional), and your mailing address including street address, city, state, ZIP code, and county.
4. If your home address is different from your mailing address, complete the section for your home address by providing the necessary street address.
5. In Section C, if applicable, provide your current employer's name, contact person, address, city, phone number, and ZIP code. If you do not have a current employer or if you are a foster parent or voluntary registrant, leave this section blank.
6. Proceed to Section D, where you must review the authorization statement and then sign and date the form. Your signature permits the Missouri Department of Health and Senior Services to conduct your background screening.
7. Finally, save your changes, download your completed form, print it if necessary, and share it as instructed. Be sure to send the registration form, a copy of your Social Security card, and the required fee to the specified address.

Complete your Background Clearance Form - Hssu online today to ensure your registration in the Family Care Safety Registry.