Three forms are required for fingerprint-based criminal background checks for licensed or regulated child care providers.
Please note: Not all forms are compatible with Mac programs. Before you proceed, review the following information:
List of Offenses
The offenses on this list will restrict individuals from working in a licensed or regulated early childhood service program.
Authorization to Transfer Background Check Results (SFN 375)
(This form must be typed)
Authorization to Transfer Background Check Results Therapy Provider (SFN 356)
(This form must be typed)
Instructions:
How to Complete Forms and Submit a Fingerprint-based Criminal Background Check
Therapy Service Provider Instructions
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 a blank copy of this 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 be obtained from a law enforcement agency or an authorized third-party fingerprinting agency).
(If any of the above additional items 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 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.
- 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
You will receive email instructions after the department receives your background check request.
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)
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.
- If 16 years old or younger, a parent must sign the form.
- 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.
- Self-addressed, stamped envelope.
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.
- Signature and signature date must be handwritten.
Child Protective Services form
Minnesota
You will receive email instructions after the department receives your background check request.
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.
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
You will receive email instructions after the department receives your background check request.
Ohio
No form is required.
Oklahoma
No form is required.
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
You will receive email instructions after the department receives your background check request.
Utah
A copy of a valid photo ID is required.
Child Protective Services form (1.17mb pdf)
Vermont
The signature on the form below requires a notary.
Child Protective Services form (190kb pdf)
Virginia
You will receive email instructions after the department receives your background check request.
Washington
Child Protective Services form (166kb pdf)
Washington, D.C.
Full 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
No forms are required.
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