Three forms are required for fingerprint-based criminal background checks for employment in a licensed child placement agency.
Please note: Not all forms are compatible with Mac programs.
Instructions:
How to Complete Forms and Submit a Fingerprint-based Criminal Background Check
Form 1
Personal Authorization for Criminal History Record Information Inquiry (SFN 829)
(This form must be typed)
Additional Address History
(Use as needed and attach along with SFN 829)
Form 2
Criminal History Record Check Request Form (SFN 60688)
(This form must be typed; Signature must be handwritten)
Form 3
Fingerprint Identity Verification (SFN 836)
(Print blank form)
If you have lived outside of North Dakota during the past five years, click on each state you have lived in (below) to see if you need to:
- Complete additional out-of-state authorization forms for each state you have lived in,
- Provide a copy of a valid photo ID or a copy of your social security card, and/or
- Provide an extra set of fingerprint cards (must obtained from a law enforcement agency or an authorized third-party fingerprinting agency)
If any of the above are required, they must be mailed to the Bismarck office. Please DO NOT send anything directly to other states.
Individual State Background Check Forms
Select from the list below. PLEASE READ ALL INSTRUCTIONS CAREFULLY!
Alabama
The signature on the form below must be witnessed.
Child Protective Services form
Alaska
Child Protective Services 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
California
No forms are required.
Colorado
The form below must be typed. Photo ID required.
Child Protective Services form
Connecticut
Child Protective Services form (21kb pdf)
Delaware
Complete Part 1 before printing the form for signature and date.
Child Protective Services form (48kb pdf)
Florida
Child Protective Services form (36kb pdf)
Georgia
Child Protection Services form (651kb pdf)
Hawaii
Child Protective Services form (24kb pdf)
Idaho
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
Child Protective Services form (1016kb pdf)
Kentucky
Copy of valid photo ID is required.
Louisiana
The form below requires a photo ID.
Child Protective Services form (1.15mb 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. The signature must be notarized.
Child Protective Services form (215kb pdf)
Massachusetts
No forms are required.
Michigan
A copy of a valid photo ID is required.
Child Protective Services form
Minnesota
Child Protective Services form (242kb pdf)
Mississippi
- Online form required.
- You will receive email instructions upon the department initiating a registry search.
Missouri
No additional form is required.
Montana
The signature on the form below must be notarized.
Child Protective Services form (74kb 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
Nevada
The form below requires a photo ID, DO NOT NOTARIZE.
Child Protective Services form
New Hampshire
The signature on the form below must be notarized.
Child Protective Services form
New Jersey
Child Protective Services form
New Mexico
- The form below must be typed.
- The signature must be notarized.
Child Protective Services form (1mb pdf)
New York
The signature on the form below must be notarized.
Child Protective Services form (84kb pdf)
North Carolina
The form below must be typed and requires a copy of a valid photo ID.
Child Protective Services form (1.3mb pdf)
Ohio
- Form below must be typed.
- Requires a copy of a valid photo ID and a copy of the applicant's social security card.
- Results will be mailed to the applicant.
- Applicant must forward them to the Criminal Background Check Unit in Bismarck.
Child Protective Services form (138kb pdf)
Oklahoma
Does not maintain a public registry.
Oregon
The form below must be typed.
Child Protective Services form (837kb Word doc)
Pennsylvania
Child Protective Services form
Rhode Island
No forms are required.
South Carolina
You will receive email instructions after the department receives your background check request.
South Dakota
The signature on the form below must be notarized.
Child Protective Services form (81kb pdf)
Tennessee
No forms are required.
Texas
The signature on the form below must be notarized.
Child Protective Services form (509kb pdf)
Utah
The form below requires a photo ID.
Child Protective Services form (1.17mb pdf)
Vermont
No forms are required.
Virginia
- The signature on the form below must be notarized.
- The form must be printed 2-SIDED (on one sheet of paper).
Child Protective Services form (198kb pdf)
Washington
The form below must be typed.
Child Protective Services form (166kb pdf)
Washington, D.C.
- The signature on the form below must be notarized.
- The form requires full 18 years of address history.
Child Protective Services form (494kb pdf)
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.
Contact Information
Criminal Background Check Unit
600 E. Boulevard Avenue, Department 325
Bismarck, ND 58505-0250
Phone: (701) 328-7575
Toll-Free: (800) 472-2622, 711 (TTY)
Fax: (701) 328-0358
Email: dhscfscbc@nd.gov