DPICRC form.doc 2025

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The document DCD 0112 outlines the process for verifying criminal record checks for public school employees working with children in programs regulated by the North Carolina Division of Child Development. It includes sections for listing staff, types of programs, background check details, and requires a signature from a school official to confirm that employees have passed the necessary checks. The form is intended for verification purposes only and must be returned to the Division of Child Development.

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Click ‘Get Form’ to open the DPICRC form in the editor.
Begin by entering the School System L.E.A Name and School Name in the designated fields at the top of the form.
Fill in the Mailing Address accurately to ensure proper communication.
Select the Type of Program by checking the appropriate boxes, such as Preschool Education or Before/After School Care.
Indicate your ID# if licensed by DCD, and provide details for any other relevant programs.
In the Type of Background Check Completed section, check all applicable boxes to specify which checks have been performed.
Ensure that a Superintendent of Schools or Principal signs and dates the form at the bottom for verification purposes.
List staff members who work with children on the reverse side, including their Full Name, Date of Birth, and last 4 digits of Social Security #.

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