Adult Abuse Registry - Check Request Form - dlp vt 2026

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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