Scr 1 form 2011-2026

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4.3 out of 5

124 votes

The document is a State Central Registry Disclosure Form issued by the Louisiana Department of Children and Family Services, which must be completed by individuals associated with licensed child care facilities. It outlines the requirements for disclosing personal information and the consequences of providing false information, including potential misdemeanor charges. The form collects details such as name, address, date of birth, and any history of abuse or neglect findings.

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Click ‘Get Form’ to open the SCR-1 form in the editor.
Begin by entering the 'Name of Licensed Facility' and its 'Physical Address'. Ensure accuracy as this information is crucial for identification.
Fill in the 'License #' field, followed by your personal details including 'Name of Individual/Applicant', 'Date of Birth', and 'Social Security #'.
Provide any previous names used in the 'Maiden, Previous or Any Other Name Used' section, along with your race and sex.
Complete your current address details, including street address, city, state, and zip code. Also include your most recent previous address.
Input your current home phone number, cell phone number, and work phone number. This ensures that you can be contacted if necessary.
Indicate whether you are currently recorded as a perpetrator on the State Central Registry by checking the appropriate box.
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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Versions	Form popularity	Fillable & printable
2013	4.8 Satisfied (124 Votes)
2011	4.3 Satisfied (124 Votes)

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