Doh chrc form 102 2026

1. Click ‘Get Form’ to open the doh chrc form 102 in the editor.
2. Begin with Section 1, where you will enter your personal information. Fill in your last name, first name, middle initial, date of birth, mother’s maiden name, any aliases, and your mailing address including city, state, and zip code.
3. Proceed to Section 2 for attestation. Carefully read each statement regarding your application for direct care or supervision. Check the appropriate boxes indicating your criminal history status and provide explanations if necessary.
4. In Section 3, input the agency's authorized person information. Include the agency name, operating license number, and the authorized person's details such as their printed name, title, signature, and date.

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