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(CHRI) Check (PDF) - uchospitals

(CHRI) Check (PDF) - uchospitals 2026

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37 votes

The document is an authorization form for a Criminal History Records Information (CHRI) check for health care workers in Illinois. It allows various entities, including the Illinois Department of Public Health and law enforcement agencies, to access and share the individual's criminal history to assess their suitability for employment, training, or volunteering in health care. The form requires personal identification details and includes consent for the release of information while outlining potential consequences for false statements.

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Click ‘Get Form’ to open the (CHRI) Check (PDF) - uchospitals in the editor.
Begin by filling in your personal information. Enter your First Name, Full Middle Name, and Last Name in the designated fields.
Provide your Mailing Address, City, State, and Zip Code accurately to ensure proper identification.
Complete the sections regarding gender, race, height, weight, date of birth, and Social Security Number. This information is crucial for identification purposes.
Indicate if you have ever had an administrative finding of Abuse, Neglect or Theft by selecting 'Yes' or 'No'. If applicable, provide details in the space provided.
Answer whether you have been convicted of a criminal offense other than a minor traffic violation. Again, if applicable, provide full details.
Review all entered information for accuracy before signing and dating the form at the bottom.

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Versions	Form popularity	Fillable & printable
2021	4.9 Satisfied (25 Votes)
2020	4.6 Satisfied (56 Votes)
2015	4.8 Satisfied (161 Votes)
2013	4 Satisfied (37 Votes)
2011	4.8 Satisfied (28 Votes)
2007	4.2 Satisfied (55 Votes)