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
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
Frequently Asked Questions
- All child care owners, operators, directors, in-home providers, staff members, and emergency designees, upon hire and at least once every five years thereafter.
- Any individual residing in a home where care is provided who is age 18 and older, upon application, renewal, or upon moving into residence and at least once every five years thereafter.
- Any individual residing in a home where care is provided who is under the age of 18 but assists in providing care to any child in the home.
- Volunteers, support staff, including therapists and extra-curricular programming, that may have unsupervised access to any child in care shall meet the qualifications equivalent to a staff member responsible for caring for or teaching children.
- Board Designees for any child care with a governing board.
Fingerprint-based background checks include all convictions spanning your adult life, and all convictions are reviewed prior to the completion of a background check.
If you have a conviction for any of offenses below you are not eligible for employment in a licensed or regulated Early Childhood Services program.
- Abuse or Neglect of a Child
- Aggravated Assault
- Arson
- Assault
- Assault or Homicide While Fleeing Peace Officer
- Burglary – B Felony
- Child Procurement
- Continuous Sexual Abuse of a Child
- Corruption or Solicitation of Minors
- Domestic Violence
- Drug Related Offense Committed During Preceding 5 years (Felony offenses)
- Facilitating Prostitution
- Gross Sexual Imposition
- Homicide
- Human Trafficking
- Kidnapping
- Luring Minors by Computer or Other Electronic Means
- Murder (18 USC § 1111)
- Promoting Prostitution
- Robbery
- Sexual Performance by Children
- Sexual Imposition
- Sexual Abuse of Wards
- Sexual Assault
- Simple Assault – A Misdemeanor
- Spousal Abuse - Felony
- Terrorizing
If you have a conviction for any of offenses below you are not eligible for employment in a licensed or regulated Early Childhood Services program unless it has been at least 5 years since you completed your sentence. After such period of time, and without subsequent conviction, the department may determine an individual determined rehabilitated.
- Criminal Coercion
- Harassment
- Reckless Endangerment
- Simple Assault – B Misdemeanor
- Stalking
- Background checks in which a child abuse/neglect finding was been made against an individual are reviewed by the CBCU Program Administrator and/or the ECS Program Administrator on a case-by-case basis. Additional information may be requested for review before a determination of rehabilitation can and/or will be made.
- Failure to disclose involvement in a child abuse/neglect case will results in the processing of your background check being denied.
- Background checks are required prior to licensure and/or employment and at least once every five years thereafter.
- Five years from the date a background check is completed, not full calendar years.
- If is recommended to submit a background check renewal at least 90 days prior to the expiration of the existing background check.
Potential staff, volunteers, therapy providers, including extra-curricular programming, who HAVE NOT lived outside of North Dakota during the past five years may work unsupervised upon qualifying results of the following:
- A Federal Bureau of Investigation fingerprint-based criminal history record using Next Generation Identification;
- A search of the National Crime Information Center's National Sex Offender Registry;
- ND State criminal history record; and
- An in-state search of the following registries, repositories, or databases:
- ND State sex offender registry;
- ND Offenders Against Children Registry; and
- ND Child Abuse and Neglect Index.
- A search of ND Public Access and MN Court Records websites.
Potential staff, volunteers, therapy providers, including extra-curricular programing, who HAVE lived outside of North Dakota during the past five years may work:
- SUPERVISED upon qualifying results of the following:
- A Federal Bureau of Investigation fingerprint-based criminal history record using Next Generation Identification; or
- ND State criminal history record; and
- ND Child Abuse and Neglect Index.
- UNSUPERVISED upon qualifying results of the above in addition to:
- A search of the National Crime Information Center's National Sex Offender Registry;
- An in-state search of the following registries, repositories, or databases:
- ND State sex offender registry;
- ND Offenders Against Children Registry; and
- ND Child Abuse and Neglect Index.
- A search of ND Public Access and MN Court Records websites.
- An inter-state search of the following registries, repositories, or database for each state where such staff member resided during the preceding five years:
- State criminal record repository;
- State sex offender registry; and
- State-based child abuse and neglect registry and/or database.
- If an individual who has completed a fingerprint-based background check for one early childhood services program moves to another early childhood services program, the original fingerprint results may be used if the individual has NOT been separated from childcare employment for more than 180 days.
- For child care owners and/or operators (only if transitioning to a staff role for another provider), staff members, emergency designees, and volunteers:
- To transfer the results, you must complete SFN375 Authorization to Transfer Background Check Results - Early Childhood
- Submit completed form to:
- Department of Health and Human Services Criminal Background Check Unit
- 600 East Boulevard Avenue, Dept. 325 Bismarck, ND 58505-0250
- Fax: 701-328-0358
- Email: dhscfscbc@nd.gov
- For therapists and extra-curricular programing:
- To transfer the results, complete SFN356 Authorization to Transfer Background Check Results - Early Childhood (Therapy Provider)
- Submit completed form to:
- Department of Health and Human Services Criminal Background Check Unit
- 600 East Boulevard Avenue, Dept. 325 Bismarck, ND 58505-0250
- Fax: 701-328-0358
- Email: dhscfscbc@nd.gov
No, background check results are not transferrable from State to State.
Yes, a new background check specifically for child care is required. Per FBI regulations, the results of a fingerprint-based background check can only be used for the purpose intended at the time of fingerprinting.
Currently, all child care related background checks are paid for by the Department.
1. The Department provides 8 fingerprinting locations throughout the state. Call to schedule an appointment.
- Bismarck - West Central Human Service Center (701-328-8862)
- Dickinson – Badlands Human Service Center (701-227-7500)
- Devils Lake - Lake Region Human Service Center (701-477-9050)
- Fargo - Vocational Rehabilitation Services (701-298-4623)
- Grand Forks - Northeast Human Service Center (701-795-3000)
- Jamestown - South Central Human Service Center (701-253-6300)
- Minot - North Central Human Service Center (701-857-8500)
- Williston - Northwest Human Service Center (701-774-4600)
You must bring a valid government issued photo ID (driver’s license, state ID, military ID, passport, tribal ID). If you do not have a valid photo ID, you will not be fingerprinted.
- Minors that do not have a driver’s license or state issued photo ID may use a current school photo ID with their birth certificate.
- Minors that do not have a driver’s license, state issued photo ID, or a current school photo ID may use their birth certificate. A parent must accompany them and present a valid photo ID.
You must bring all your completed authorization forms, including authorization forms or other required items for other states to your appointment.
2. Law enforcement agencies, or any other agency that is authorized to conduct fingerprinting.
- You are responsible for paying any fees charged for fingerprinting.
- Contact the agency for days and times they do fingerprinting.
- You must bring a valid photo ID (driver’s license, state ID, military ID, passport, tribal ID).
- If you do not have a valid photo ID, you will not be fingerprinted.
- You must bring a blank Fingerprint Identity Verification Form (SFN 836) to be completed by the official that rolls your prints.
- You are responsible for mailing all your authorization forms, authorization forms for other states and fingerprints to the Criminal Background Check Unit in Bismarck.
- Ink-rolled fingerprints MUST be sealed in an envelope by the official that rolled your prints BEFORE giving you the print cards.