Get Fl Care Provider Background Screening Clearinghouse Background Screening Request Form 2020-2025

Completing the FL Care Provider Background Screening Clearinghouse Background Screening Request Form is an essential step in the background check process for health care and service providers. This guide will provide clear, step-by-step instructions to help you efficiently fill out the form online.

Follow the steps to successfully complete the background screening request form.

1. Press the ‘Get Form’ button to access the background screening request form and open it for editing.
2. In the 'Applicant Information' section, enter your first name, middle name, and last name. Make sure all names match your identification documents.
3. Specify your sex by selecting either 'Male' or 'Female'.
4. In the 'Demographics' section, indicate your race by circling one of the options: White, Black, Asian, American Indian, or Other.
5. Fill in your hair color and eye color in the respective fields.
6. Provide your Social Security Number (SSN) in the designated field.
7. Enter your height and weight, ensuring that the information is accurate.
8. Input your date of birth in the required format.
9. Indicate your place of birth, specifying either the US state or foreign nation of birth.
10. In the 'Contact Information' section, complete your address by filling in Address Line 1, and if applicable, Address Line 2.
11. Include your city, state, and zip code, as well as the county where you reside.
12. Provide your email address and phone number to ensure you can be contacted.
13. Review all the provided information for completeness and accuracy before submission.
14. Once you are satisfied with your entries, save the changes, and download, print, or share the completed form as needed.

Start filling out your background screening request form online today!