300-1590 (11-18) CAREGIVER BACKGROUND SCREENING-2026

1. Click ‘Get Form’ to open it in the editor.
2. In Block I, Section A, select the type of screening you require by checking the applicable boxes. Options include child abuse or neglect file, family foster care licensing, and state criminal background check.
3. Complete Section B with the requestor's information, including name, telephone number, address, and signature. Ensure all details are accurate for confidentiality.
4. In Block II, Section C, the caregiver must provide identifying data such as their full name, social security number, date of birth, and addresses for the last three years.
5. Section D requires the caregiver's signature to authorize the release of background check information. This must be done in front of a notary public if screening type 1 is selected.
6. Finally, complete Block III with return address information for where responses should be sent. Review all sections for completeness before submission.

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