Scr 1 form 2011-2026

1. Click ‘Get Form’ to open the SCR-1 form in the editor.
2. Begin by entering the 'Name of Licensed Facility' and its 'Physical Address'. Ensure accuracy as this information is crucial for identification.
3. Fill in the 'License #' field, followed by your personal details including 'Name of Individual/Applicant', 'Date of Birth', and 'Social Security #'.
4. Provide any previous names used in the 'Maiden, Previous or Any Other Name Used' section, along with your race and sex.
5. Complete your current address details, including street address, city, state, and zip code. Also include your most recent previous address.
6. Input your current home phone number, cell phone number, and work phone number. This ensures that you can be contacted if necessary.
7. Indicate whether you are currently recorded as a perpetrator on the State Central Registry by checking the appropriate box.
8. Finally, review all entered information for accuracy before signing and dating the form at the bottom. Ensure that both you and a licensed facility representative sign where required.

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