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Click ‘Get Form’ to open it in the editor.
Begin by filling out the 'Applicant Information' section. Ensure you print legibly in black ink or type. Include your last name, first name, maiden name, middle name, gender, date of birth, driver's license number, social security number, current address, and home phone number.
Provide your previous address information if applicable. Fill in the city and state for each previous address along with the dates you resided there.
Select your staff position from the options provided. If applicable, describe your position clearly.
Answer the questions regarding any felony or misdemeanor convictions and investigations for abuse or neglect. Attach explanations where necessary.
Sign and date the application at the bottom of the form to authorize processing by the Utah Department of Health.
Complete the 'Covered Entity/Employer Information' section by indicating whether this is an initial application, renewal, or change of ownership. Fill in all required details about your employer.

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What is DACs in Utah?

DACS was created to help protect some of Utahs most vulnerable populations. It is an automated fingerprint-based background check system which allows online tracking of applicants and sends auto generated notifications. DACS allows the background check clearance to be shared among long term care providers.

What is the Commercial Finance registration and disclosure Act in Utah?

Commercial Financing Registration and Disclosure Act Utah Code 7-27-201 It is unlawful for a person to engage in a commercial financing transaction as a provider in Utah or with a Utah resident unless the person: (i) registers with the Department in accordance with this chapter; and.

What is the alternative teaching license in Utah?

Alternate Path to Professional Educator Licensure (APPEL) is a program created and managed by the Utah State Board of Education to provide those who already have a bachelors degree the opportunity to earn a teaching license.

What is deferred prosecution in Utah?

What is Deferred Traffic Prosecution? If you get a ticket, Deferred Traffic Prosecution can keep points off of your driving record. If you qualify, you pay a fine like a normal ticket. Depending on your record, you might also have to take traffic school online and pay for that.