Three forms are required for fingerprint-based criminal background checks for employment in a Certified Shelter Care, Supervised Independent Living Program, Qualified Residential Treatment Program (QRTP) or a Psychiatric Residential Treatment Facility (PRTF)
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 2a
Criminal History Record Check Request Form (SFN 60688)
(This form must be typed; Signature must be handwritten.)
Form 2b (PRTF ONLY)
Non-Criminal Justice Request Form (SFN 50744)
This form must be typed. No signature is required. IMPORTANT NOTE: Dakota Boy's & Girls Ranch Minot Employees must complete Form 2a AND Form 2b.
Form 3
Fingerprint Identity Verification (SFN 836)
(Print a blank copy of this form. This form is NOT required for PRTF-only employees.)
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 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 the form below must be witnessed.
Child Protective Services form
Criminal History Record Information form (PRTF only)
Alaska
Child Protective Services form
Criminal History Record Information form (PRTF only)
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
Criminal History Record Information (PRTF only)
California
No forms are required.
Colorado
You will receive an email with instructions after the department receives your background check request.
Connecticut
Child Protective Services form
Criminal History Record Information form (PRTF only)
Delaware
Complete Part 1 before printing the form for signature and date.
Child Protective Services form
Florida
Child Protective Services form (36kb pdf)
Georgia
No form required.
Hawaii
Child Protective Services form (24kb pdf)
Idaho
Signature must be notarized.
Child Protective Services form
Criminal History Record Information form (PRTF only)
Illinois
Child Protective Services form (415kb pdf)
Indiana
- Online form required.
- You will receive email instructions upon the department initiating a registry search.
Iowa
- DO NOT change Requestor Information!
- Complete one form for EVERY last name you have had
- Print the completed form for signature.
Criminal History Record Information form (PRTF only)
Kansas
Child Protective Services form
Kentucky
- Copy of valid photo ID is required.
- Self-addressed, stampled envelope.
Criminal History Record Information form (PRTF only)
Louisiana
The form below requires a photo ID.
Child Protective Services form
The form below requires an additional set of fingerprints.
Criminal History Record Information form (PRTF only)
Maine
- Complete only if you are 18 yrs old or older
- This form CANNOT BE TYPED
Child Protective Services form
Maryland
The form below must be typed. The signature must be notarized.
Child Protective Services form
Massachusetts
Criminal History Record Information form (PRTF only)
Child Protective Services form
Michigan
- A copy of a valid photo ID is required.
- Signature and signature date must be handwritten.
Child Protective Services form
Minnesota
Child Protection Registry ~ You will receive email instructions after the department receives your background check request.
Criminal History Record Information form (PRTF only)
Mississippi
- Online form required.
- You will receive email instructions upon the department initiating a registry search.
Criminal History Record Information form (PRTF only)
Missouri
You will receive email instructions after the department receives your CPS background check request.
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
Criminal History Record Information form (PRTF only)
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
Criminal History Record Information form (PRFT only)
New Jersey
Child Protective Services form
New Mexico
- Instructions and authorization form will be emailed to the requesting agency and the applicant.
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
Criminal History Record Information form (PRTF only)
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
Criminal History Record Information form (PRTF only)
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
An extra set of fingerprint cards are required.
Criminal History Record Information form (PRTF only)
Tennessee
No forms are required.
Texas
You will receive email instructions after the department receives your background check request.
Utah
The form below requires a photo ID.
Child Protective Services form
Criminal History Record Information form (PRTF only)
An extra set of fingerprints is required.
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
Criminal History Record Information form (PRTF only)
West Virginia
Child Protective Services form
Wisconsin
No forms are required.
Wyoming
An extra set of fingerprint cards is required.
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