Licensed or Regulated Child Care Providers

Alabama

The signature on this form below must be witnessed.

Child Protective Services form 

The signature on this form below must be witnessed by two people OR it can be notarized; an extra set of fingerprints cards are required; and a copy of a valid government issued photo ID is required.

Criminal History Record Information form 

Alaska

Child Protective Services form 

Criminal History Record Information form 

Arizona

Child Protective Services form 

Arkansas

• Complete the form below - notary not necessary.
• Due to their requirements, a second form will be generated by the CBCU and it will be emailed directly to you.
• The online-generated form DOES require a notary.
• Mail the completed form to the CBCU. Please Do NOT mail it to Arkansas.

Child Protective Services form

The signature on the form below must be notarized.

Criminal History Record Information form 

California

No forms are required.

Colorado

The form below must be typed. Photo ID required.

Child Protection Services form

Connecticut

On the form below, enter N/A in any field that does not apply to the applicant.

Child Protective Services form (192kb pdf)

Delaware

• Complete Part 1 before printing the form for signature and date.
• If the applicant is under the age of 18, the form below must be signed by a parent or guardian.

Child Protective Services form (48kb pdf)

An extra set of fingerprints cards are required.

Criminal History Record Information form (748kb pdf)

Florida

Child Protective Services form (40kb pdf)

Georgia

No forms are required.

Hawaii

Child Protective Services form (24kb pdf)

Idaho

• If the applicant is under the age of 18, the form below must be signed by a parent or guardian.
• Signature must be notarized.

Child Protective Services form (2.61mb pdf)

Illinois 

Child Protective Services form (415kb pdf)

Indiana

• Online form required.
• You will receive email instructions upon the department initiating a registry search.

Iowa

No forms are required.

Kansas

• Complete the Applicant Section on the form below
• NO sections can be left blank.
• Enter N/A if a section does not apply to the applicant.

Child Protective Services form (1017kb pdf)

Kentucky

Copy of valid photo ID is required.

Criminal History Records Request form (32kb pdf)

Louisiana

• The form below is only required if the applicant is 18 years old or older
• Requires copy of a valid photo ID

Child Protective Services form (1.15mb pdf)

An extra set of fingerprints cards are required.

Criminal History Record Information form (1.20mb pdf)

Maine

• Complete only if you are 18 yrs old or older.
• This form CANNOT BE TYPED.

Child Protective Services form (130kb pdf)

Maryland

• The form below must be typed
• Signature requires a notary

Child Protective Services form (214kb pdf)

Massachusetts

Child Protective Services form (130kb pdf)

This form below requires a copy of a valid photo ID.

Criminal History Record Information form (230kb pdf)
 

Michigan

A copy of a valid photo ID is required.

Child Protective Services form 

Minnesota

• The signature on the form below requires a notary.
• If the applicant is under the age of 18, the applicant's parent or guardian will also need to sign AT THE SAME TIME IN FRONT OF NOTARY.

Child Protective Services form (64kb pdf)

Mississippi

• Online form required
• You will receive email instructions upon the department initiating a registry search
• The signature on the form below must be notarized; requires copy of valid photo ID

Criminal History Record Information form (48kb pdf)

Missouri

You will receive email instructions after the department receives your background check request.

Montana

• The signature on the form below must be notarized.
• If the applicant is under the age of 18, the applicant's parent or guardian must complete the Authorization for a Minor letter.
• The parent or guardian signature must be notarized.

Child Protective Services form (95kb pdf)

Authorization for a Minor (103kb pdf)

Nebraska

• The signature on the form below must be notarized.
• If the applicant is not 19 years old or older, the applicant's parent or guardian must sign the form.

Child Protective Services form 

The signature on the form below must be notarized.

Criminal History Record Information form 

Nevada

A copy of a valid photo ID is required.

Child Protective Services form 

New Hampshire

The signature on the form below requires a notary.

Child Protective Services form 

• The signature on the form below requires a notary
• Self-addressed stamped envelope required.

Criminal History Record Information form 

New Jersey

Child Protective Services form (90kb pdf)

New Mexico

Child Protective Services form (234kb pdf)

The signature on the form below requires a notary.

Criminal History Record Information form (879kb pdf)

New York

The signature on the form below requires a notary.

Child Protective Services form (865kb pdf)

North Carolina

No forms are required.

Ohio

No form is required.

Oklahoma

Child Protective Services form (173kb pdf)

Oregon

The form below must be typed.

Child Protective Services form (837kb Word docm)

Pennsylvania

• All sections of the form below must be completed.
• If a section does not apply to the applicant, enter N/A.

Child Protective Services form

Rhode Island

• The signature on the form below requires a notary
• Copy of a valid photo ID is required.

Criminal History Record Information form (1.42mb pdf)

South Carolina

You will receive email instructions after the department receives your background check request.

South Dakota

Complete the form below ONLY if the applicant has been the subject of a child abuse/neglect report in South Dakota.

Child Protective Services form (26kb pdf)

An extra set of fingerprints cards are required.

Criminal History Record Information form (99kb pdf)

Tennessee

No forms are required.

Texas

The signature on the form below requires a notary.

Child Protective Services form (509kb pdf)

Utah

A copy of a valid photo ID is required.

Child Protective Services form (1.17mb pdf)

• An extra set of fingerprints is required.
• Copy of a valid photo ID is required.

Criminal History Record Information form (580kb pdf)

Vermont

The signature on the form below requires a notary.

Child Protective Services form (190kb pdf)

Virginia

The signature on the form below requires a notary.

Child Protective Services form (198kb pdf)

• The form below will be generated by the Criminal Background Check Unit upon receipt of your background check request.
• An email will be sent to the provider and the applicant with instruction on how to complete and submit the form to our office.

Criminal History Record Information form (52kb pdf)

Washington

The form below must be typed.

Child Protective Services form (166kb pdf)

Washington, D.C.

This form must be typed. Five year address history and Photo ID are required.

Child Protective Services form (721kb pdf)

A copy of a valid photo ID is required.

Criminal History Record Information form (26kb Word docx)

West Virginia

Child Protective Services form

Wisconsin

This form requires a witness signature.

Child Protective Services form

Wyoming

Instructions will be emailed to the applicant.