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The document is an authorization form for conducting child abuse and neglect background checks by the North Dakota Department of Human Services for individuals involved in early childhood services. It includes sections for personal identification, assurance of no criminal history against children, consent for information release, and certification of the provided information's accuracy. The form also outlines the mandatory disclosure of social security numbers for licensing purposes.

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Versions	Form popularity	Fillable & printable
2012	4.9 Satisfied (220 Votes)

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