nd.gov - The Official Portal for North Dakota State Government
North Dakota: Legendary. Follow the trail of legends
NDDHS logo
 arrow iconDHS Home arrow iconContact DHS arrow iconSkip Navigation Space
Space
about arrowAbout DHS
Space
services arrowServices and Help
Space
business arrow iconBusiness Services
Space
onlineServ arrowOnline Services
Space
locations arrowDirect Service Locations
Space
providers arrowProviders
Space
news arrowNews Room
Space
Space
careers arrowHuman Resources/Jobs
Space
policymanuals arrowDHS Policy Manuals
Space
info arrowPublications/Research
Space
Space

Criminal Background Checks

Licensed or Regulated Child Care Providers

List of Offenses that will restrict you from working in a licensed or regulated early childhood service program.

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.

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.

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.

Select from the list below. PLEASE READ ALL INSTRUCTIONS CAREFULLY!

Alabama Georgia Maine Nevada Pennsylvania Washington
Alaska Hawaii Maryland New Hampshire Rhode Island Washington, D.C.
Arizona Idaho Massachusetts New Jersey South Carolina West Virginia
Arkansas Illinois Michigan New Mexico South Dakota Wisconsin
California Indiana Minnesota New York Tennessee Wyoming
Colorado Iowa Mississippi North Carolina Texas  
Connecticut Kansas Missouri Ohio Utah  
Delaware Kentucky Montana Oklahoma Vermont  
Florida Louisiana Nebraska Oregon Virginia  

Alabama

The signature on this form below must be witnessed.

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.

Alaska

Arizona

Arkansas

The signature on the form below must be notarized.

The signature on the form below must be notarized.

California

  • No forms are required.

Colorado

This form MUST be typed. Must enter all children or N/A if you do not have children.

Connecticut

On the form below, enter N/A in any field that does not apply to the applicant.

Delaware

If the applicant is under the age of 18, the form below must be signed by a parent or guardian.

An extra set of fingerprints cards are required.

Florida

Georgia

  • No forms are required.

Hawaii

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.

Illinois

Indiana

  • Online form required. You will receive email instructions upon the department initiating a registry search.

Iowa

Kansas

Complete the Applicant Section on the form below - NO sections can be left blank. Enter N/A if a section does not apply to the applicant.

Kentucky

Louisiana

The form below is only required if the applicant is 18 years old or older; requires copy of a valid photo ID.

An extra set of fingerprints cards are required.

Maine

Complete only if you are 18 yrs old or older. This form CANNOT BE TYPED.

Maryland

The form below must be typed; signature requires a notary.

Massachusetts

This form below requires a copy of a valid photo ID.

Michigan

A copy of a valid photo ID is required.

Minnesota

The signature on the form below requires a notary. If the applicant is under the age of 18, the applicant's parent or guardian will also need to sign AT THE SAME TIME IN FRONT OF NOTARY.

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.

Missouri

The signature on the form below cannot by typed. The form must be printed for signing.

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.

Nebraska

The signature on the form below must be notarized. If the applicant is not 20 years old or older, the applicant's parent or guardian must sign the form.

The signature on the form below must be notarized.

Nevada

A copy of a valid photo ID is required.

New Hampshire

The signature on the form below requires a notary.

The signature on the form below requires a notary; self-address stamped envelope required.

New Jersey

New Mexico

The signature on the form below requires a notary.

New York

The signature on the form below requires a notary.

North Carolina

Ohio

Oklahoma

Oregon

The form below must be typed.

Pennsylvania

All sections of the form below must be completed. If a section does not apply to the applicant, enter N/A.

Rhode Island

The signature on the form below requires a notary; copy of a valid photo ID is required.

South Carolina

The signature on the form below requires a notary.

South Dakota

Complete the form below ONLY if the applicant has been the subject of a child abuse/neglect report in South Dakota.

An extra set of fingerprints cards are required.

Tennessee

  • No forms are required.

Texas

The signature on the form below requires a notary.

Utah

A copy of a valid photo ID is required.

The form below requires fingerprints to be entered directly on the form; a copy of a valid photo ID is required.

Vermont

The signature on the form below requires a notary.

Virginia

The signature on the form below requires a notary.

The form below will be generated by the Criminal Background Check Unit upon receipt of your background check request. An email will be sent to the provider and the applicant with instruction on how to complete and submit the form to our office.

  • Criminal History Record Information form (52kb pdf)

Washington

The form below must be typed.

Washington, D.C./District of Columbia

The form below requires full 18 years of address history. The signature on the form must be signed in blue ink.

A copy of a valid photo ID is required.

West Virginia

Wisconsin

The form below is only required if you lived in Milwaukee County. The signature must be witnessed.

Wyoming

Contact Information

Criminal Background Check Unit
600 East 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

 

Return to the top of the page Top of page   Go back to the previous page Back to previous page
   
  arrowNondiscrimination Policy  arrowClient Rights & Appeals  arrowLimited English  arrowDisclaimer  arrowPrivacy Policy  arrowSecurity Policy  arrowHIPAA Privacy Notice 

Copyright © 2016 NDDHS. All rights reserved.
 Get Adobe Acrobat Reader Tested for W3C WAI AA Accessibility Tested for W3C Well-Formed XHTML Code Tested for W3C Well Formed Cascading Style Sheet Code