Adult Abuse Registry - Check Request Form - dlp vt 2026

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  1. Click ‘Get Form’ to open the Adult Abuse Registry - Check Request Form in the editor.
  2. Begin with Section I, where you will enter the employer's name, address, phone number, fax number, and email address. Ensure all information is accurate and clearly typed.
  3. In Section I, certify that the individual is a current employee or has a conditional offer of employment by signing and dating the form.
  4. Move to Section II for the consent from the current or prospective employee. Fill in their full name, gender, address, phone number, date of birth, place of birth, last four digits of SSN, and any other names used.
  5. Authorize the release of information by having the staff member sign and date this section.
  6. Leave Section III blank as it is for office use only. Once completed, mail your form along with a self-addressed stamped envelope to the specified address.

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Vermont Adult Protective Services: call (800) 564-1612, submit an online report, or email APS@vermont.gov. Nursing Home/Long-Term Care Abuse: call Survey and Certification (888) 700-5330 or email AHS.DAILSCIntake@vermont.gov. Long-Term Care Ombudsman: (800) 889-2047.
Almost all States maintain a statewide central registry, which is a centralized database of child abuse and neglect investigation records. In some States, the individual State agencies that received the reports of suspected abuse or neglect are required to maintain these records.