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)
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 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
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
You will receive an email with instructions after the department receives your background check request.
Connecticut
Child Protective Services form
Delaware
Complete Part 1 before printing the form for signature and date.
Child Protective Services form
Florida
Child Protective Services form
Georgia
No form required.
Hawaii
Child Protective Services form
Idaho
Signature must be notarized.
Child Protective Services form
Illinois
Child Protective Services form
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
Kentucky
Copy of valid photo ID is required.
Louisiana
The form below requires a photo ID.
Child Protective Services form
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
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
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.
Missouri
You will receive email instructions after the department receives your background check request.
Montana
The signature on the form below must be notarized.
Child Protective Services form
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
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
North Carolina
The form below must be typed and requires a copy of a valid photo ID.
Child Protective Services form
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
Oklahoma
Does not maintain a public registry.
Oregon
The form below must be typed.
Child Protective Services form
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
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
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
Vermont
The signature on the form below requires a notary.
Child Protective Services form
Virginia
You will receive email instructions after the department receives your background check request.
Washington
Child Protective Services form
Washington, D.C.
Full five year address history and Photo ID are required.
Child Protective Services form
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