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Dshs background check authorization form

Dshs background mailing address form 2026

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The document is a Background Authorization form used for requesting background checks by various entities, including DSHS staff, providers, and applicants. It includes sections for entity information, applicant details, and specific requirements based on the type of service (e.g., Children's Administration, Economic Services Administration). The form requires personal identification information, consent for background checks, and acknowledgment of legal implications for providing false information. Instructions emphasize the importance of completing all sections accurately to avoid delays.

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Click ‘Get Form’ to open the dshs background mailing address form in the editor.
In Section 1, provide the name of the person or entity requesting the background check. Ensure clarity and accuracy.
Fill in the complete mailing address of the requester as required. If not applicable, indicate 'N/A'.
For Children’s Administration, enter the name of the facility or foster home if applicable.
Sign and print your name in the designated area to confirm your request for a background check.
Proceed to Section 2, where you will input personal information such as your Social Security Number (optional), date of birth, and current address.
Answer all questions honestly regarding any criminal history or previous names used. Use 'NONE' where applicable.
Finally, review all entries for accuracy before signing and dating the form at the end.

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